Monitors beep. A healthcare worker, suited up in a medical gown, face shield and other personal protective equipment, hands a patient an oxygen mask. Beep. “I can’t breathe,” a man says. Beep. A doctor intubates a patient. Beep. Another doctor calls out, “Check the x-ray.” The beeps grow louder, closer together. A woman appears limp.
“The simulation is ended,” a voice finally says.
The scene in Netflix’s Pandemic: How to Prevent an Outbreak, filmed in 2019, grips the viewer within the first five minutes of the six-part docuseries. Syra Madad, a leading epidemiologist in the United States and the senior director of the System-wide Special Pathogens Program at New York City Health + Hospitals, was overseeing the tense simulation. At the time, Madad was working with New York City healthcare workers to prepare them for what the infectious disease expert said was inevitable.
“What worries me is that it just takes one person to start an outbreak,” Madad says in the documentary. “We’re basically human incubators. We can host a number of different diseases. It’s just a matter of time where the next pandemic is going to start. We don’t know where or how, but we know it will.”
The Netflix series and Madad’s warning were eerily prescient. The episodes were released in the United States on January 22, 2020, one day after the Centers for Disease Control and Prevention confirmed the first coronavirus case in the country. For Madad and her team, their simulations had quickly become reality.
“We are involved in all phases of disaster response,” Madad tells Al Jazeera on Zoom more than a year after the series was released.
“This could be preparedness, response, mitigation, containment and recovery,” the 34-year-old adds. “With COVID-19, we are in almost all of these different phases at once.”
On this particular day in early March, Madad was examining her teams’ efforts surrounding COVID-19, addressing some of the resources they were developing for vaccine hesitancy and building confidence in the coronavirus vaccine, and looking at their Ebola plans and updating training videos.
It is likely more than many do in a week, or a month, but Madad speaks humbly about her work, giving credit to the many women in public health, and those in her life who have helped her get to where she is today.
One of these women sits next to Madad on the Zoom video call, her mother-in-law, Dr Saiyeda Madad.
“She has played an instrumental role in who I am,” Madad explains, smiling gently at her mother-in-law, who is a retired paediatrician and lives with Madad and her family.
“When I got married 10 years ago, I was completely new to the whole family dynamic, not just keeping a family together but feeding a family and being a working mom,” Madad says. The epidemiologist has three children, aged one, five and seven. Her team and the city activated its incident command structure for COVID-19 on January 21, 2020, just eight days after Madad gave birth to her daughter.
“I have learned a lot of things from her, but in particular, she has taught me to balance that work and family life,” Madad explains, pointing to the many formal and informal cooking lessons her mother-in-law provided.
Diagnosed with Parkison’s and dementia, Saiyeda Madad does not say much as she listens to her daughter-in-law speak, but in the few words she does say – she enjoyed “everything” about when she was working – and how her face lights up when Madad addresses her, it is easy to tell how proud she is of her work and her daughter-in-law.
“She has taught me to [realise] that not only can I excel in my respective fields, public health and healthcare, but to also [realise] that as a mother, as a daughter-in-law, as a wife, I can also give the good balance act that we often play,” Madad explains.
Madad also says she could not have got to where she is today without her anchor – her mother, 61-year-old Rehana Sikandar.
Sikandar immigrated to the US from Pakistan with her husband, Madad’s father, when she was 18 years old. The couple hoped to provide their future children with the opportunities they did not get when they were young.
“She always wanted to go to school. She always wanted to become a teacher herself and she just wasn’t able to attain that,” Madad says. “And so, she has certainly instilled in us to constantly reach, not only for the stars, but do more than what we’re doing.”
In many ways, Madad says, she is “taking up the mantle” from her mother and showing her and others that as, “a Muslim woman, a Pakistani woman, an American woman, we can break cultural barriers and all the different cultural norms”.
“She was certainly a motivational factor for me,” Madad says.
Sikandar has always been supportive of her daughter, but she does have the same worries any mother would have, especially for a child who works in public health.
“My spark in public health and infectious disease, and in particular, highly infectious disease, came at a very young age,” Madad says, recalling the time she first saw the 1995 film, Outbreak, and later read the nonfiction book it is loosely based on, The Hot Zone, by Richard Preston.
In the film, a team of doctors and scientists, played by a star-studded cast – Dustin Hoffman, Rene Russo and Morgan Freeman, among others – are fighting the fictional, fast-spreading Motaba virus in the small made-up town of Cedar Creek, California. The film is a tense thriller, but for a young Madad, it had a lasting impact.
“When I had mentioned to my mother early on that I was interested in infectious diseases, she was a little scared when she saw that I was really interested in that film,” Madad recalls.
Nearly two decades later in 2014, when Madad, responding to the very real Ebola disease, suited up in personal protective equipment to enter a high containment zone in Texas, she got a call from her mother, worried about her daughter’s safety.
“She always plays that role, reminding me to just take a step back and ask, ‘Is this safe and is this something that you feel comfortable doing?’” Madad says. “Time and time and again, whether it is Ebola or COVID-19, she still plays that same role, asking, ‘Are you taking care of yourself? Are you being safe?’ … I get that call from her every single day.”
A ‘three-pronged approach’
When Madad is not suiting up in PPE to fight Ebola or COVID-19 on the public-facing front lines, she is behind the scenes, working to make sure healthcare workers and health systems are as prepared and well-resourced as they can be.
Her work and expertise were not only highlighted in the Netflix docuseries, but also in the recent Discovery Channel documentary, The Vaccine: Conquering COVID.
In one scene in Netflix’s Pandemic, Madad speaks to the leaders of New York City hospitals and gets updates on flu cases. In another scene, she is in a New York state senator’s office, asking for his support in pushing the state to help fund critical preparedness programmes, and in another, she is picking her sons up from school.
“It’s kind of a three-pronged approach,” Madad says, reflecting on how she manages it all. “It’s obviously making sure that you’re paying full attention at the workplace, it is making sure that you’re paying your full attention at home with your family, and then also being part of the community.”
The last aspect is particularly important to Madad, especially as a Muslim American. In her faith, Madad has been inspired by Zaynab bint Ali, the granddaughter of the Prophet Muhammad, who is revered for her work in caring for the sick and poor.
“She was not only a mother, but a daughter. She was a sister, and she took these roles and made sure that [not] only did it shape who she was, but also to show the world that women play such a pivotal role in society, in the community,” Madad says.
Zaynab teaches that ”you don’t have to just kind of plough through things, you can have a humanistic approach to it, and that you can be all that you can be in the midst of everything that’s going on around you,” she explains. “She played a pivotal role in history, she is kind of the shining light, and a prime example for not just Muslim females, but for women all around the world.”
A silent workforce
In many ways, Madad herself is also a shining light for women worldwide. Her passion for her work, her pioneering spirit, her tireless effort to ensure her staff and healthcare workers globally are prepared and well-resourced to fight infectious diseases, and her devotion to her family and community, is simply an inspiration.
But it is the women who helped Madad along the way, and the other women in the field of public health, that she holds up as the true heroes.
“There are so many women in this world that have shaped and continue to shape public health as we know it,” Madad says.
“Oftentimes you may not hear about them, you may not see what we’re doing, but we are the invisible workforce that is really making sure that we can continue to thrive and live the healthiest life possible,” she adds. Women play a “pivotal role” in society, especially in public health and “shaping who we are and how we prevent the next pandemic”.