Genomic Epidemiologist Krisandra Allen, MPH, MB(ASPC)

One thing I loved about the MPH program was that there were people from every background. So health economics or behavioral health and all of those things coming into EPI bring such valuable perspective. So don't be afraid to lean into your experiences and what those bring to you as an EPI and to whatever organization you work for. Hello and welcome to the podcast Epidemiology, a podcast where we hear from epidemiologists about their specialties and how they got into their fields as well as turning points that shaped their careers. I'm Dr. Casey Ingalls, a disaster epidemiologist working in governmental public health and if you're thinking about studying epidemiology or you want to learn more about the field or just curious about what EBS actually do, I'm glad that you found the show. On today's episode we're talking with Chrysandra Allen, a genomic epidemiologist in Shilwaqa through how her love for microbiology and statistics helped her find the field of epidemiology. I would say it goes back to my undergrad days so I was getting my bachelor's degree in microbiology and I had to take the general statistics course that everyone had to take for that degree and I found that I enjoyed the course so much that I decided to add a statistics minor and so then I started looking around going, "Well, I really like microbiology and statistics. What discipline is out there that combines those two things?" And so that's where I landed on epidemiology. Where did you go to undergrad at? So that was at the University of Idaho in Moscow, Idaho out in the wheat fields. I originally started actually an engineering and decided after statics that I did not really love engineering and I took, I was just kind of taking different courses to see what resonated with me and what I enjoyed and I took the general microbiology course and it had a really, really strong lab component and I really enjoyed being in the lab and looking under the microscope and seeing the bacteria and that really kind of kickstarted my love for microbiology and pathogens. Why did you decide it was the University of Idaho? Is that right? What was it about that school that kind of drew you to it? I had been over there, I had gone to a summer camp there and I'm not really a city person so it's the location kind of, I wanted to go somewhere that I had a distinct campus where it wasn't just downtown or part of a city so I really appreciated that aspect and it was really affordable so that was a benefit too and I really, really enjoyed my time there. Did you take F.E. classes when you were in undergrad or not quite yet? I did not so at the time there were no F.E. classes available so I just took a pathogens course, a microbiology one but there was no F.E. specific courses so my first real introduction was as I was thinking about what I wanted to do. I actually attended the Society for Healthcare Epidemiology of America conference and it was a training course before the conference where they were teaching clinicians how to do things like use a 2x2 table to catch a little heat, concert shows and things and how to draw an epic curve and all of those things really made a lot of sense to me and I found that I was helping a lot of the clinicians around me and the course go oh no this is how you understand the statistics of what we're doing here and that really was another key point where I said all right this is the direction that I want to go. So there were no F.E. courses I guess. How did you find this conference? Did you just like Google what does microbiology and statistics have in common? How did you even become aware of this field? Some of it was from popular books like The Hot Zone, reading books like that. Yeah so not one aha moment but just kind of a slow exploration. So after undergrad did you pursue a position in F.E. or did you like straight to your MPH? Yeah so I stuck around in Idaho for a year and worked in a research lab which was really fun but also taught me that that wasn't what I wanted to do all the time. What was the research? It was about a soil bacterium called mixococcus antis and I was attempting to crystallize a protein which is a very particular and finicky process but I did learn that mixococcus antis is one of the things that makes dirt smell like dirt. So if you go into the EG banner and you bring out the plates and you'd smell it and go that's dirt. So maybe if I had been working on pathogens it would have peaked my interest a little more rather than environmental microbes. Got it. And that's a different smell than the smell right after it rains right? That's not the same thing. Not the same thing. After that point that's when I did decide to go to grad school and get my MPH in epidemiology. How did you decide which school to go to? Yeah I don't know that it was the best criteria but I grew up on the west coast and had gone to undergrad in Idaho and decided I wanted to try somewhere east coast. So ended up going to Virginia Commonwealth University in Richmond, Virginia. Nice. I did a very similar thing. I was like I went to UW for undergrad. I'm going to go live on the east coast and I went to grad school in Boston. It wasn't adjustment. How was Virginia? It was good. But the weather in the summer for a native Seattleite was rough with the heat and humidity. But it was a really good experience and I'm glad that I did it. I think living in different places and meeting different people is a really good experience to do as you're coming of age. When you joined your MPH program did you pick the, because there's like the Bioskats and EPI track or were you considering like a different track there or how did you decide? The EPI track, I was pretty sure from the start that I wanted to do the EPI one. But one thing that I really appreciated about the MPH degree was that I got to, you know, you take not just your focus track classes so you get to take behavioral health and policy and politics and we get to go over and sit in general assembly sessions and things like that. So it was a really good, strong at the education, but also, you know, exposing you to the wider world of public health. Yeah, my MPH program was similar. Although I do remember they made me take a, like a healthcare, healthcare finance class where we had to do a budget for a hospital system and I was like, I do not want to do this required. You prefer different kind of number crunchy. Please do not make me calculate how much these machines cost and it was too much. It was, yeah, that was, that was a really rough class. Teacher was great, but not my cup of tea. What year did you graduate with your MPH? Well, that is a bit of a story. So I started in 2005, ended in 2009 because I had my first son in 2007. So oh nice, congratulations. Yeah. Yeah, it's really hard to be a parent and be in school. So speaking from experience on that, did you have to do like an applied learning experience or any kind of, I guess, what was the, do you like a big project for your MPH program? Yeah, so I was right at the transition. So I did a project, so an applied analysis project. And then the classes that were coming in right as I was finishing up were switching to having an applied experience or internship much more strongly than my class was encouraged to do that. Okay, what was your project? So it was using Oregon Prams data and looking at the effect of multivitamin use on pretty clamps, yeah. Okay, can you explain what Prams is? Yes, now I'm trying to remember that it's a pregnancy risk assessment monitoring system. So I had coordinated nationally, but done at a state level. So you can analyze the whole national data set or specific state level data after you got your MPH, did you have like a position lined up afterwards? We're gonna stay in Virginia. - Yeah, so I did not have a job lined up and had my next child in 2010. So ended up just taking some time off completely while they were both little and then ended up getting my first EPI job in May of 2012 and it was, I will say, challenging to go from grad school to being a stay-at-home parent to then trying to find your first job in public health. So that was not easy and got a little discouraging at times feeling like I was applying and applying and I wasn't sure where I was ever gonna find a role. But I ended up joining a small local health district in Virginia, but that was a really, really great first experience because I was the only EPI in the health department and we covered seven counties, although across those seven counties, there was only about 112,000 people. - Oh, okay. - Very rural area, but I was the EPI for basically everything on the reportable disease list outside of tuberculosis and sexually transmitted infections. Those were handled by the public health nurses, but everything else on the reportable disease list was fair game for me. So it was a really great chance to get exposed and learn how to become an instant expert on every pathogen. - I guess backing up a little bit when you were applying for your jobs, was there anything that you were doing 'cause I feel like I mean, I took statistics and I haven't used it in years. Was there anything that you were doing to maintain your skills or were you doing side projects or anything like that? Or I mean, I also have small children. There is not a lot of time in the day, but was there any, I guess, additional things that you were doing that you thought were helpful in finding this position at the local health jurisdiction? - I don't know that it was actually helpful, but I was back at least at that time period. There was a CDC field epi manual that had all sorts of information. And so I would review that. So I went into my interviews like with the 10 steps of an outbreak investigation in my account. I could only imagine that the interview, they're like, oh, you must have been. You're not watching the manual. - You know, there's 10 steps. - How did, was the transition go from being like this day at home parent to then working full time and commuting? And I just, I feel like that must have been just like a big transition in general. - It definitely was challenging. They were four and two at that point. So still pick them up from daycare and get home. And that's all I did. The rest of the evening was spent time with them, take care of them, do all those things. So it was definitely not an easy transition, but I really, really enjoyed the work and the environment. So that makes a big difference. - Yeah, yeah, I know. It's hard to drop them off with him. He's like, all right, I'll see you in 10 hours. - Okay, so then you started and you were the only happy, I guess like what was your role? - Yeah, it was kind of everything. So I did the surveillance reporting of, you know, is classifying cases. Is this a confirmed case of pertussis? And then I did a lot of the kind of boots on the ground of going out to facilities when there were outbreaks. I had one of the first outbreaks I worked on was group A Strip in a nursing home. So they got so used to me that I kind of had a permanent home in one of their conference rooms where I'd sit and review medical records and things like that. - How did you, I guess how did you learn how to do that? If there was no other epi there showing you the ropes, was it just a lot of trial and error? Did you have a mentor in a different department that was kind of not that department, but it's like in a different health department that was kind of walking you through that? - Yeah, so one thing I really enjoyed the way that Virginia Department of Health was organized was that in addition to what I was called a regional or a district epidemiologist. And then there were regional epidemiologists who served as a resource to all of the district epidemiologists within that region. So that I leaned both on my peer district epidemiologists in the region as well as our regional who did a lot of that mentorship and took all the phone calls of, I don't know what this means. What do I do? - And how long, I guess how long did you work there for? - Yeah, so I worked for about a year at that local health department. And then I had the opportunity to move to the state central office and started working in the foodborne disease program at that point. - Okay. - And were you doing similar like investigations and those kinds of things? - Yeah, so it was a little different at the local level. It's you do the things, you go out and collect specimens sometimes or give direct advice or go to the facilities at the central office or state level. It was much more kind of communicating with the locals and saying, hey, you have two summoner cases that are genetically linked 'cause a lot of what my role was coordinating with the public health laboratory called DCLS. And taking the gedomic data that they would create using a technology called PFTE. And so they would give us information and say, hey, these two summoner cases match, go find what's in common, see if there's an outbreak. And so a lot of my job was kind of communicating both up to CDC if there was multi-state investigations and then communicating over to the local health departments that were the ones actually contacting and connecting with the patients. - Got it. So you're already kind of starting 'cause you do like genomic epi now. So you are already kind of in the genomic epi field in the foodborne team. - Kind of. - Exactly. - Yeah, that's really where it all traces back to. - And can you just talk a little bit about how you determine if it's the same strain of a pathogen? How do you determine if it's the same type of salmonella or what have you? - Yeah, so that changes over time. So back when I started in 2012, 13, 14, it was what often people will call DNA fingerprinting or post-field gel electrophoresis. And I won't spend too much time on that 'cause it worked great, but it has now been superseded. So what is generally done now is sequencing where you can actually look, you know, the DNA of the pathogen, whether it's virus bacteria, fungi is made of your DNA bases. And with sequencing, you can actually read off the entire genome. There's a whole lot of work that goes into the bioinformatics of it of taking all that raw data and assembling it into useful information. But using those advanced laboratory and bioinformatics methods, you can do things like identify amicrobial resistance genes present in your organism. You can do clustering analysis to say, you know, these two samples are really close to each other genomically. - And why, from a public health standpoint, is that important to know? Like why is that important information? - So by identifying when people are infected with a very similar organism, that lets you know that they may be connected through some chain of transmission or some potential source. For example, if it's salmonella, it may be that they, if you have three people and the lab says, hey, we sequenced them, they're all identical or almost identical, and you go talk to them, you may find out that they all ate at restaurant A or you may find out sometimes it's much more difficult to find out because it may be an ingredient. So maybe they were all making baking at home and it was actually caused by the flower. So it really helps guide your public health investigations and the ultimate goal is always to use that information to then take public health. health action. So whether that is, you know, recalling a product or if you find transmission within a healthcare facility, you know, looking at do they need to update their procedures or things like that? Okay. And then if, if, for a new salmon, like example, like if it shows that they're a completely different strains of salmon, then how would that kind of determine what you would do in the investigation? You would, you would just kind of understand like, okay, well, then maybe they didn't eat the same thing or they didn't use the same ingredient. So we do like a more thorough kind of investigation because then you now you have like two separate exposures, right? Yeah. So the genomic data can be used to both rule in or attempt to rule in and rule out connections. So it, if you, if you're just looking at your, you know, we're checking all the salmonella and you see two that are really distinct from each other, you're not going to put a lot of effort or time into looking for connections because the genomics is suggesting that there's not a connection. It, where it can get interesting is I worked on one outbreak and it was in a product called Cradle, which is a herbal product that's, that's grown and packaged and that outbreak actually ended up having five, at least five different types of salmonella in the outbreak. Oh, wow. Okay. Sometimes you can get the case where you're really genomically distinct pathogens, but they're actually all linked back to the same source. Okay. And the only way really to figure that out is through like epi and investigations. Right. And that one, it was product testing. So they were, we were able to implicate, hey, based on our FBE investigations, we think it's this product and then they tested the product and said, Oh, actually, there's like five different salmonella in here, but take that and then go back and find all the human cases that matched all those additional strains. Cronet. Okay. Fascinating. Fascinating. Yeah. And I know I'm sure we'll get to that, but I feel like most people are probably familiar or became familiar with like genomic epi because of the pandemic and like, right, that's where you have like the Omicron variant and like those kinds of things. But I'm sure we'll talk about that. So okay. So you're working at the state for Virginia and foodborne working with the lab and coordinating like that testing. I guess, did you were like, Oh, I want to work in food like this is where I want to be? I like foodborne or were you thinking that you wanted to do more like micro bio in the future? Or I guess what was your next step after after that position? Yeah. I really, really loved foodborne. And I still do. I think it's one of the most fascinating areas of infectious disease epidemiology. I did take a pause from my epi work and went over and spent a year and a half actually in the public health laboratory doing hands-on testing for neurovirus and neuroviruses. What was the reason for that change? You just missed being in the lab or just looking for something different? Yeah. I just I enjoyed so much working so closely with the lab that I wanted to see if I can remember how to use a pipette. So you're working in the lab. Do you have any interesting things that you tested at the lab that were surprising to you or that kind of through you for a loop or was it pretty much, you know, same thing every day, testing for neurovirus. What was the other virus you said you were testing for? Ineroviruses. Ineroviruses. Okay. And what are those? Oh, those are my favorite pathogen. So they can cause all sorts of diseases from what feels like a cold to stomachache to something called hand foot and mouth disease. Oh, with parents usually. I am familiar with that as of a couple of weeks ago. Yes. It's a very versatile group of viruses. In 2014, there was a large outbreak in the US of anerovirus D68, which was causing severe respiratory illness in children. So we were working at the public health lab to be able to identify, because most clinical labs didn't have the capabilities of specifically identifying that one particular virus. So we developed, we used a CDC method to be able to identify and actually be able to say definitively, yes, this, this child that's very sick does have this particular anerovirus strain. Can you talk a little bit more about like the CDC method and how you develop the ability to like test for certain pathogens at all? Yeah. So with that CDC method, it was actually based on sequencing. So a little bit of a foreshadowing of what I worked on later. So it used a sequencing technology called Sanger sequencing, which is typically used to look at short segments of the genome. So with anerovirus is there's a one particular segment of the genome that you can sequence and that gives you enough information to say, you know, this isn't an anerovirus D68 versus a different, there's hundreds of different aneroviruses. So that was, that was really fun because it, it always felt a little bit like opening a present every time I finished the sequencing run because it wasn't just a yes-no, it was, oh, that's a weird one. I've never, we haven't gotten that one before. Okay, so you're working in the lab and then you decided what did you do after that? Was there another kind of like avenue that you wanted to go towards or was your next step? I reverted and went back to foodborne epi. So I kept, kept coming back to that a lot. Yeah. It's at the state in Virginia too, right? Like a different. So state, first back at the state in Virginia, and then I was on a national call with a bunch of other foodborne epi partners and the lead of the foodborne epi program in Washington state said, oh, and by the way, we're hiring for another foodborne epi and the position closes tomorrow. I said, oh, am I, am I ready to move back to the west coast? I don't know, so I'm just going to apply and then I'll decide. And it was the fastest government hiring process I had ever seen. And I had about two weeks and had a job offer and then had to decide that is fast. Wow. I don't know what was going on there, but it was, had to make a quick decision on uprooting the whole family and moving back to the west coast. Okay, so now you're working for the Washington State Department of Health and on the foodborne team, are you doing similar work where you're like coordinating with the lab or are you doing more epi investigations rather than like lab work? I was working really close with the lab still, and it was a really fun time because the lab was transitioning from that older methodology of P, P F T E to the newer methodology of sequencing. So it was, it was really fun to be working alongside the lab as they, they made that transition. And as we were kind of all trying to learn together, how do we, how do we understand and use this data? Yeah. And how I guess what goes into like a big transition like that? Like do you, do you like, I don't know what I'm talking about? Do you like calibrate it with like the old system to like the new system? Or it just seems like it's a very big shift. So like what's kind of involved in changing systems like that? Yeah, there was a long time of doing both methods in parallel. So that was a really nice way to do it. And CDC did a lot of validations of looking at the old clusters defined by P F T E and outbreaks and then sequencing them and seeing how they, how they were concordant or discordant. And then so we used, we continued to use the P F T E data for a long time. And then just slowly over time, if, if for example, we saw something that wasn't resolving, how we thought it might need to with P F T E, then we would start looking at the sequencing data. And as we did that more and more over time, we gained confidence in both that we believe the sequencing data was telling us good information and just getting used to the systems and the data and how to incorporate it. So I feel like people are used to hearing like, oh, you got to, like you got a test and it gets maybe sent to the lab. They're probably thinking like, oh, I got my nose swabbed. Like how, what are you testing for foodborne? Are you testing like samples that you receive from people, are you testing, like you had mentioned before, like products, or what were you primarily sampling? Yeah, the testing. Public health labs tend to do it all. So they will usually be getting samples from clinical labs. So if you go to a hospital and you think you might have salmonella or something or you doctor does, they'll usually collect a stool sample. They'll send that to their hospital lab and then that lab will culture it or test it to see. And if they identify a positive, then they will forward that to the public health lab. And then there are other programs that are looking, for example, at retail meat. So there's actually inspectors that will go out and collect ground beef or raw chicken and things like that and take those to the public health lab for them to test to see if what pathogens are in those food products. Interesting. Is it like a secret shopper? I don't think there were a tag that says, "We're here to test your meat." Yeah. Okay. Yeah, I'm glad that somebody is doing that. I didn't know that job existed. Okay. So you're doing these foodborne investigations. You're working with the lab in Washington state and I guess how long did you do that for? Because you worked for Washington for a number of years. I was doing that very happily until COVID ruined it. So started in 2017 and that was what I was doing until 2020 when like many, many other epidemiologists I got redirected into becoming a COVID epidemiologist. What was your role during the pandemic? That is a big question. So I had a lot of different roles. It started out, I ended up doing a lot of informatics projects. So I had been wanting to use a particular system called RedCap for our foodborne outbreak investigations. It's a tool developed and supported by Vanderbilt University. And it allows you to collect health information from people. So we'd use it in surveys of, you know, if you have an outbreak sadly at a wedding reception. It's a tool that would allow you to securely send everyone a survey that you could ask them, you know, did you have the royal oysters? Did you have the cake and then analyze the data? So I had been wanting to use that system and had been in the approval processes through the state to be able to use that. And when COVID happened, it was quickly realized that, oh, really need to be able to collect information securely and rapidly from people on and off site. So I ended up working on getting RedCap up and running for the Washington State Department of Health. And as part of that, the first real use case was for drive-through testing. So if you rewind back to the early pandemic days, you know, nobody could get tested and lots of people wanted to get tested. So the federal government came and would bring supplies and people, but there was not infrastructure for the tracking of getting people appointments or registering or things like that. So what I did for the first several months is just built out registration systems so that we could have online registration for folks. So we didn't end up with lines of people around the block trying to get tested because there were so many more people that wanted to be tested than there were slots available. So you did informatics work for a little bit. You got the RedCap form set up. And how long did that take you? I mean, everything was moving so quickly. It was about two weeks from when I was told, "Hey, we're going to have this drive-through testing site on this day to all right, I got two weeks to figure this out." And it ended up, you know, I think I finished it at like 11 o'clock on a Friday night and it was all over the Seattle news the next Saturday, the next morning. And I was just crossing my fingers that I really hoped that this works and doesn't give everybody appointment slots. Yeah, oh, that's stressful. Oh, yeah, yeah, that sounds really stressful. Okay, so you did that for two weeks and I'm sure you had many other visits. I did that for two weeks and then, you know, it worked really well. So it expanded and we used that system for a long time to support drive-through testing sites across the state. So it ended up being a really, really useful tool. And so I stayed on various informatics projects till about August of 2020. Okay. And then what did you start doing in August of 2020? Yeah, so the whole time I was doing these informatics projects, I was simultaneously kind of raising the flag saying, "Hey, we should sequence this virus. Hey, researchers at the University of Washington are sequencing. We should work with them or pay attention." So I said it enough times that in September of 2020, I was able to move into an official molecular epidemiologist role and really be given the mandate of, all right, figure out what we can do for sequencing SARS-CoV-2 and what can we learn for it and how can we use that data?" Did that molecular epidemiologist role exist already? Or was it? It did not. It did not. Yeah. Do other states or had other states developed like molecular epidemi programs or was Washington like one of the firsts that had done that? I think Washington was one of the first. There may have been that particular role in other states previously, but I think especially in expanding it into a full team and things like that, I think Washington was definitely on the leading edge there. That's really cool. Okay, so now you're leading a molecular epidemi team. How many epidemiologists did you have on your team? It changed over time. And then I was also working really closely with our Zoonotic Disease Program lead, was really instrumental as well. So it was a team effort and then we started, you know, during the COVID days, we were still in instant management structure. So it was a lot of borrowing people and getting temporary people and then ended up with two or three long term permanent folks on the team. So we've decided that we're going to start sequencing COVID tests. Do you, when you sequence something, do you have to do it right away? Or so it was like we started sequencing like then in August or were you able to like go back in time to sequence or how does that work? Yeah, you can definitely freezer dive. The biggest limitation is just whether it was retained. So a lot of times, you know, clinical labs, public health labs may not have the space to keep everything, especially your hospital labs. So they usually turn over pretty quickly within a week or so. They'll be discarding specimens. Just they don't have the space in the freezer is to keep them. How do you kind of get like a global picture? Like, you know, when we'd, you know, we'd hear on the news like, okay, there's a Delta wave, but that would be, it's not just like our state that we're talking about, you know, when we see that. So how does all that information get put together to have like a one overarching picture of what the current variant is of any particular pathogen? Yeah, that is one of my favorite things about sequencing is it kind of a universal language. So there are databases that researchers from around the world, one of the ones we use extensively is run by the US government and CBI. And that's a open access. All of the sequence data is free live available for researchers and public health users across the world to aggregate and analyze. So there was a lot of, you know, at the national level CDC was looking into those different databases and drawing the data out, making those national proportions and things like that at the global level, WHO was doing the same thing to be able to, you know, identify variants of concern or things like that. One thing that is really, really cool about sequencing is the way that you can submit it to these public data repositories, which then really magnifies the utility of the data. Is sequencing pretty time intensive to do or are there moments for it's like, oh, we're not going to sequence this specific test. Yeah. It is a time intensive. It's getting easier. You can-- there's more automated systems now available. But it actually, one of the most difficult parts is getting the specimens. So one of the biggest barriers in public health sequencing is if it's not a pathogen that's required to be routinely submitted to the public health lab, then you're not going to be able to sequence it very often because it's going to stay at the clinical lab and then get discarded. So that getting samples in the door is one of the biggest bottlenecks and challenges for sequencing. Yes, you're working for the Washington Department of Health. You're doing sequencing. How long did you do that for? And I remember correctly, I feel like you had-- you've told a really interesting story. I heard on social media, or like LinkedIn, about you had a meeting, right? Put the governor? Was that? Yeah. Yeah, that was always-- during-- I think it was during the alpha wave. So when variance really kind of first became common at parlance, and people were really paying attention, the state epidemiologist message me and said, hey, I'm on a call with the governor. I want you to come along. And it was a really neat experience. It was not something I had put on my epi-bingo card, expecting to happen anytime soon. But being able to see-- we know how public health is connected to policy and policies government and being able to see kind of a political leader wanting to hear from the scientists was really pretty encouraging to see. Yeah, that sounds like a really cool experience, behind me. I feel like on your post, it was like you had like a sign on your door. Yeah, it was well school from home was happening. Yeah. So I was a little worried that I was going beyond with the governor and have a small face pop up over my shoulder. Sure, it would have been understanding. I think everybody had a lot going on at home. OK, and then eventually you no longer worked for the Department of Health. And you've moved to-- is industry, or is it-- are you in an industry field now? Yeah. Public health can be a really challenging field to be in sometimes. So was it hard to move from being in like state public health to industry? Yeah, so I worked in governmental public health for about a decade when I decided that I wanted to move into kind of the public health adjacent space in the private sector. So I've worked a couple of different places in the last four years. And it's been really, really fun to be able to-- I still work really closely alongside public health. But there's a little more flexibility when you're not working directly within the government. So it's been great to be able to support public health partners and really enable them to do their mission better. And are you still doing like genomic epi style of work? Yeah, so I focus on bioinformatics and genomic epi and think about everything from metadata, cleaning, to phylogenetic trees all the time. If someone was like, I want to become an epidemiologist, I guess, what would you tell them either about the field or if they're specifically interested in genomic epi? Is there any specific advice that you would give them? Yeah, I think it would depend a little bit on where they are. So whether they're high school or undergrad or looking for grad school. But I think the biggest thing that I have learned is to invest in yourself. I've had a lot of opportunities because I've taken the time to make friends, to make connections, to do-- I've done a lot of thinking outside of my day job, a lot of reading. And whatever, there are a lot of routes to get to the same destination. And so I always encourage people to be flexible. You might come through a similar route of lab to epi and in genomic epi. One thing I'd loved about the MPH program was that there were people from every background. So health economics or behavioral health and all of those things coming into epi brings such valuable perspective. Thank you for listening to this episode of EpiDemiology. Be sure to click the follow button on your podcast app. See you don't miss a new episode of the show. And if you have any questions about EpiDemiology or suggestions for future guests or if you're interested in being on the podcast yourself, please drop a comment on this episode or send me a note on the EpiDemiology substack, which will be linked in the show notes. Again, I'm Dr. Kise Engels and you've been listening to EpiDemiology.