31. Making Scents of COVID

Contagious Conversations  /  Episode 31: Making Scents of COVID





Claire Stinson: Hello, and welcome to Contagious Conversations. I'm your host, Claire Stinson. Every episode, we'll hear from inspiring leaders and innovators who make the world healthier and safer for us all. Contagious Conversations is brought to you by the CDC Foundation, an independent nonprofit that builds partnerships to help the Centers for Disease Control and Prevention save and improve more lives.

Joining me today are Carol Edwards and Dr. Carol Glaser. Carol Edwards began her career in dog obedience training at the age of 13, and since then, has immersed herself in the behavioral science of dog training. Dr. Carol Glaser is the assistant deputy director in the Office of the State Public Health Laboratory Director and medical officer for infectious disease laboratories at the California Department of Public Health. Dr. Glaser is also the laboratory director for the California Department of Public Health's K-12 School Antigen Program. Welcome to you both and thank you so much for joining us today.

Carol Edwards: Thank you for having us.

Dr. Carol Glaser: Pleasure to be here.

Claire Stinson: It's a pleasure. I'm excited to talk to you both about this unique program. Dr. Glaser, let's start with you. Tell us about your background and your role at the California Department of Public Health.

Dr. Carol Glaser: So, I have kind of an unusual background. I first trained in veterinary medicine and then because I had a very strong interest in the overlap of veterinary medicine and human medicine, I then attended medical school. After medical school, I completed a pediatric residency, and then went on to complete a pediatric infectious disease fellowship. This training has really been invaluable when encountering diseases that are transmitted from animals to people. We call those zoonotic diseases. This includes rabies and plagues and hantavirus, and really, literally hundreds of other diseases. Also, what got me interested in this whole field of looking at dogs for the detection of infectious disease. It was my role here at the California Department of Public Health, where we were working with various testing programs as it related to COVID-19, we built a very large program and we implemented it through many of our schools in California. We began to think about how we could improve the testing that we are currently doing in schools and really led me to what we're going to talk about more today.

Claire Stinson: Fascinating. That's an interesting background and I'm sure we'll talk more about how your background influenced your participation in this program. Carol, please tell us about your background and about the mission of Early Alert Canines.

Carol Edwards: Basically, I've been training service dogs for about 25 years now. Started out with Guide Dogs for the Blind, a puppy raiser for them, raising dogs for them. Realized pretty early the dog's ability to detect hypoglycemic episodes in humans, and that really launched me into training diabetic alert dogs, which is what I've been doing for the last 20 years. I've placed about 150 teams in that time. It always fascinated me that the dogs are faster than most of the technology that we have out there.

Claire Stinson: Oh, wow. That is a very, very amazing statistic. I'm sure it's very true. I'm a dog lover and I will enjoy talking to you both about this really important program. Dr. Glaser, the Department of Public Health is collaborating with Early Alert Canines on the COVID-19 Detection Dog Program, using dogs to screen for COVID-19. Tell us more about the program and how you came to be connected with it.

Dr. Carol Glaser: Basically, as part of the Governor's Testing Task Force here in California, in the fall of 2020, we started to figure out how we could get testing in many of our schools, because we knew that if we could get testing, it would actually keep a lot of kids in school and we were really anxious to keep our schools open. After months of trial and error, we were able to figure out how to put in a very robust, scalable program that used antigen testing throughout California. Currently, we have about 4,000 schools that are part of this testing program, and it's worked out really well. However, the program is burdensome in terms of staff time that's needed to perform that test, kids have to come out of the classroom to get tested, and then also, we have a disadvantage of this testing program that it's a nasal swab, so it's somewhat invasive as far as the specimen collection. We were interested in figuring out, could we find something that had time-saving and a less invasive method for testing?

Because of my background in veterinary medicine, I was aware of dogs' phenomenal sense of smell, and we know that they've been used throughout the world to detect other infections like tuberculosis, Clostridium difficile, and malaria. As the pandemic unfolded, we and the schools' team had been following reports from around the world where dogs were used in various settings to screen for COVID-19, and so we began to explore that potential and actually was referred to the Early Alert Canines to see if they would be interested. Maybe Carol can take it from here about our early conversations…

Carol Edwards: Yeah. Back in June of last year, Dr. Glaser called me and we started a conversation about, she started out with the question is, "Do you think dogs can detect COVID-19 in humans?" My answer to her was yes. And I think she got really quiet at that point and I found that since in working with her, that's always not a good thing, but I think she was surprised that I agreed so readily and so easily. The one thing I've learned through the years is their noses are absolutely phenomenal and we've only hit the tip of the iceberg on what these dogs can do and how they can help us in our human worlds. I found it very exciting to be on the ground floor of this project, working in tandem with CDPH to see if we could accomplish this.

Claire Stinson: What a fascinating story. Were you surprised at all that the dogs were able to do this pretty quickly?

Carol Edwards: No. My concern at the onset was, how are we going to collect samples? Because I would need a good sample to make sure that the dog was hitting on the right thing. Dr. Glaser made sure that her team jumped in and helped out with us being able to collect samples properly and make sure we were collecting the right things.

Claire Stinson: Amazing. Dr. Glaser, let's talk about that process. What are the benefits of using dogs in schools instead of more traditional swap tests?

Dr. Carol Glaser: To start off, just there's less time taken away from the teachers and the other staff in performing the tests. Children do not have to spend as much time out of the classroom to get tested by the dogs. The children don't have to have that invasive nasal swab. Then the other things that people rarely think about and we should just consider is throughout this entire pandemic, we've had these ebbs and flows on the availability of testing kits and supplies. We're really at the mercy of various companies and if they're making enough, and if we can get those supplies. Clearly, if you think about the dogs, we're not going to need the availability of test kits and supplies, and indeed, antigen test kits, which is in what our whole program is based upon, we had short supplies during the early stages of the Delta and Omicron surges, so that is a huge advantage.

Another advantage that is rarely mentioned, and I never hear people talk about it when we talk about what dogs could do, is the environmental impact of this program. If you look at some of the statistics coming out, the plastic waste that has been generated during the pandemic, it is just absolutely astronomical. Depending on which paper you pick up, but some say there's greater than eight million tons of pandemic-associated plastic waste. You just have to go to any of our testing sites and you can see that just in a normal day, there's a lot of waste that's generated. The use of dogs for screening would greatly reduce the burden of testing waste on our environment.

Those are a lot of benefits, but I think most of all is just the incredible positive reaction we get from students and other staff that are at the school. They absolutely love the dogs. It wasn't surprising when we did a formal survey with parents and students about how they felt about dog screening versus the regular antigen testing, the overwhelming majority of participants favored dog testing over the nasal swab. I think Carol was on site many times as well as myself, and she can also attest to the fact that the kids, just their faces lit up when we walked into the schoolyard with the dogs.

Claire Stinson: Yeah, absolutely. Carol, please tell us more about that.

Carol Edwards: Yeah. I mean, it completely changed it from a negative - being tested, having something shoved up your nose, to a positive interaction with a dog. We even had kids that were initially afraid of dogs that learned to accept our dogs, that our dogs weren't going to hurt them in any way, they were just going to give them a quick sniff, and if they wanted to give them a pat on the head after we were all done, that was all good. I think it really took something that had been turning negative, repeated testings, repeated weekly testings, suddenly turned positive because Rizzo and Scarlet were coming and people loved to have Rizzo and Scarlet on campus.

Dr. Carol Glaser: We had to talk to parents before we introduced dogs out to the schoolyards. We had heard from some parents that, "Oh, my child's afraid of the dogs," and of course, we made this all optional, it was up to the parents if they wanted their children to participate. We heard later from many parents and even directly from the students that, "Hey, my child used to be afraid of dogs, and they aren't anymore." There were so many positive aspects of this program that went even beyond just the testing itself.

Claire Stinson: We'll be right back with Dr. Carol Glaser and Carol Edwards.

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And now, back to our conversation with Dr. Glaser and Carol.

Carol, please tell us more about the two dogs in this program. You mentioned their names, Rizzo and Scarlet. Tell us more about them.

Carol Edwards: Yes. Rizzo and Scarlet came to us from Canine Companions. Rizzo is a bit higher energy, so I knew that she'd be a perfect fit as a detection dog. She likes to go, go, go, and work, work, work. Scarlet is kind of her balance. Scarlet's a little bit more easygoing, but still has that drive to work, loves using their noses to solve problems, loves being around people and kids, and can handle the schoolyard with the balls and the bats flying and all kinds of craziness going on, and yet they can focus when we tell them to search, to look for what they've come there for, but they also enjoy the attention, so they're actually perfect ambassadors as well as detection dogs.

Claire Stinson: Well, it sounds like it. How did you select them and how did you train them to detect COVID in humans?

Carol Edwards: We worked with CDPH to collect sock samples. People that had tested positive for COVID-19 would wear a pair of socks for us. We would collect those socks and then we would teach the dogs to alert on the socks that had been worn by a COVID-19 patient. Beyond that, we transferred them to working on to students on campuses by teaching them. We would have kids face away from us, so we'd walk behind them, and we would have them sniff at the ankles. If they smelled the smell, they would sit and alert their handler that this was a positive.

Claire Stinson: Wow. That's really amazing. How are Rizzo and Scarlet doing with the training and how are they doing now?

Carol Edwards: They are eager to get back into school. They are waiting for the schools to come back into session because they want to get back to work.

Claire Stinson: Well, that's good news.

Carol Edwards: Yeah, they've done fairly well. I think Dr. Glaser can probably give you more statistics, but they are ready to go, and just waiting for the schools to open.

Claire Stinson: Well, that's great news. Dr. Glaser, has a program like this ever been implemented before? If you could, tell us a little bit about the feedback you've received from schools on the program.

Dr. Carol Glaser: Sure. When we first started this back in January of 2022, we were aware that dogs were being used in some airports and sports venues, but they hadn't in schools. I will say that actually, since we started this project and we'd been in the middle of it, we did learn of schools in Hawaii and Massachusetts that are using dogs for detection. In Hawaii, their approach is more similar to ours. In Massachusetts, it's a fairly different program, but I don't think it's any surprise, actually, that basically groups across the globe have been trying dogs.

What I think is just absolutely amazing, for instance, in France, they've used dogs from the French Fire Department. In Iran, they used five different dog breeds to try to train them on samples taken from COVID-positive patients. In the UK, they used seven different dogs, et cetera, cetera. But no matter which dogs they're used and different training techniques, they all come with the same result. It works. It works. The training might vary. The dog breed might vary a bit, but all the groups are finding the same thing, that dogs can do this, and we really think they should do this.

Claire Stinson: Wow. Thank you so much for sharing that. Carol, if you could tell us, please, what makes using dogs to detect COVID particularly unique or effective?

Carol Edwards: I think it comes back to their phenomenal noses. Because of the way they break things down, and so much of their olfactory is dedicated to scent, it's really their primary tool for identifying things, and it's figuring out how to partner with them and show them what it is you're looking for, and they happily will show it to you every single time.

Claire Stinson: Aw. Carol, tell us, what's your experience been like with this program, and what's your favorite aspect?

Carol Edwards: I truly believe in the dogs' nose, the ability that these dogs have, we have just begun to tap into that. I think it can be used for so many more things because the dogs have it, they use it every day, they use it all the time, but it's collaborating with them so that they're of effective for us. My favorite part of the program is seeing a kid that was having a bad Monday morning complete with meltdown with tears because she had to do another test, and all of a sudden, Rizzo walks in and her face lights up and she wants to be first in line, so it completely had changed the attitude that they had. The dogs absolutely love it. They love the job. They like to work. To them, it's a very happy thing. It's a hide and go seek and they get rewarded when they find it, so they like looking for it.

Claire Stinson: Well, it sounds like man's best friend is changing the world. Dr. Glaser, do you see opportunities for this kind of project during any future pandemics or outbreaks?

Dr. Carol Glaser: Oh, absolutely. Dogs are truly untapped resources in terms of biomedical detection. That actually is a quote from Dr. Maureen Maurer, who's part of the Hawaii dog program, but we really haven't used them nearly as much as we should. We know and accept that they're incredible for bomb detection, search and rescue and drugs, but we just haven't used them very much in biomedical detection. I think if we reflect back on early days of this pandemic, there was so many things that we never imagined that we would be able to do. We never imagined we'd have the massive testing programs that we had. I think that really, through this pandemic, we may really start to really see and appreciate how dogs can be used, not just for COVID-19, but for many other detections, we know that monkeypox is really becoming a huge problem, and we have talked amongst ourselves that if we had more dogs and more resources, we could probably get the dogs trained for monkeypox, but unfortunately, our resources are still limited. I think that, again, it's an untapped resource and people really need to expand our thinking around what is possible.

Claire Stinson: It certainly sounds that way. What an untapped resource, indeed. Carol, what future roles do you see for dogs in this program and for any future pandemics or outbreaks?

Carol Edwards: At this point in time, I see the dogs continuing to work on the school campuses. I love the idea of working with the younger students maybe that aren't as vaccinated yet and just seeing that grow. One of the standing jokes we have is, "I'd love to see a lab of labs. Come get your lab test here." We'll have a lab sniff you for the variety of things that we've taught them to detect and just watch them do their job. I think this is the beginning of the door opening to a much bigger discussion on what they can do. I've known for years that their abilities have been awesome in doing diabetic alert. They catch the diabetic before the blood sugar is even out of range and they let them know early that they're going to have a problem. We've seen that with the COVID dogs. Sometimes they're testing ahead of the antigen test. I think we've just opened the door into what the next stage is going to be. It's going to be, what can we get samples on and what can we teach the dogs to detect?

Claire Stinson: Absolutely. I echo that. It certainly sounds like we need a lab for labs, a lab of labs, and it certainly sounds like dogs are changing the world. This is an amazing discussion about this really important program. So many benefits, such an untapped resource. I want to thank you both for joining us today on Contagious Conversations.

Dr. Carol Glaser: Thank you.

Carol Edwards: Thank you for having us. This is a great opportunity to tell everybody about the work that we're doing.

Claire Stinson: Thanks for listening to Contagious Conversations, produced by the CDC Foundation, and available wherever you get your podcasts. Be sure to visit cdcfoundation.org/conversations for show notes. If you like what you just heard, please pass along to your colleagues and friends, rate the show, leave a review, and tell others. It helps us get the word out. Thanks again for tuning in and join us next time for another episode of Contagious Conversations.




For more, read our accompanying story about the COVID-19 Detection Dogs