Published: October 2020

If you’re looking for Lilian Peake, MD, MPH these days, you’ll find her at the center of Virginia’s community-level response to the COVID-19 pandemic as state epidemiologist and director of the Office of Epidemiology. Her current role in public health is where she feels she is meant to be, even though it is actually her second career.

Originally from Maryland, Peake recalls the influence of her pediatrician, Mary Sartwell, guiding her future in medicine. “She was an amazing, compassionate, intelligent woman,” she recalls. “When I was young, there weren’t many women in those positions, so I was very inspired by her growing up.”

Other than medicine, Peake also had interests in writing and leadership. She attended LaSalle University in Philadelphia as an undergraduate student, majoring in Business and Communications. After graduation, she spent the next 10 years in marketing and communications. “It was a really fun career. I worked for an American company that manufactured epoxy flooring systems. They wanted to set up a European subsidiary, so I lived in Luxembourg and Belgium to help them set up their company there. It was an amazing opportunity,” she says.

In her mid-20s, Peake says she had a yearning to continue to learn and started considering graduate school. The birth of her son during that time led to a fascination with the human body and how it works, giving her the motivation to do what she’d wanted to do as a child and pursue a career in medicine. She completed a Post Bacc program, and then spent the next year on her MCATs, applying for medical school, and earning an MPH from Johns Hopkins University.

When it came to choosing UVA for medical school, Peake says that Charlottesville itself was a big factor in her decision. She had visited the town in the past to see her father, a professor who would grade papers for the CFA Institute. “I was a single mother at that time, and Charlottesville felt very quaint and safe. After getting my Master’s in the city of Baltimore, I liked the idea of coming with my son to Charlottesville and to a university that felt like a close-knit community,” she says.

As someone who chose medical school later in life, Peake was the oldest person in her class. She remembers her time at UVA as a positive experience for both herself and her son. “My classmates were amazing. At times, I had to bring my son, Ryan, to class or to lab, and my classmates helped me with babysitting and things like that,” she says. “We felt like a part of that community and I have incredibly fond memories of my time there.”

When it was time to choose a specialty, Peake gave a lot of thought to what she wanted to do next, having enjoyed rotations in surgery, primary care and, in particular, ophthalmology. She was also a newlywed – she married Roger F. Gildersleeve, MD ’95, Res ’99, during her fourth year of medical school. Peake says that work-life balance was an important factor in her decision, and she ultimately selected ophthalmology and matched at MCV.

Although she enjoyed learning about the field, Peake soon questioned her choice. “I was happy to have received the opportunity to have an ophthalmology residency, but I felt like it wasn’t the right fit,” she says. “I missed using the other skills that I have. I went to the Graduate Medical Education Office and told them, and I said I wanted to use my Master’s in Public Health but I wasn’t sure how to do that.”

The GME Office connected her with Bill Nelson, MD, MPH, who was the health director in Chesterfield County, Va., at the time, and she spent a day on the job with him. “I just knew. That was what I wanted to do, and I was right. I have never looked back,” she says.

Peake switched to a preventive medicine residency, working in different areas of the Virginia Department of Health (VDH). After completing her residency, she was hired by VDH as deputy health director at the Thomas Jefferson Health District in Charlottesville. That role was followed by serving for three years as health director of the Rappahannock-Rapidan Health District, then returning to Charlottesville as director of the Thomas Jefferson Health District for eight years.

“During the time I was working in Charlottesville, I tried to lecture at every level that I could at the medical school, including with family medicine residents, and do as much as I could at UVA so that there was more understanding of what a career in public health could be for physicians,” she says.

After years spent in local health departments, Peake’s next role was at the state level as director of the Virginia’s Office of Family Health Services, where she continued her efforts in community health improvement work and helped the agency create its first state health improvement plan. Soon after, she was hired as deputy commissioner of population health.

In 2016, Peake was recruited to join the South Carolina Department of Health and Environmental Control as director of public health. There, she launched the Live Healthy South Carolina initiative. Although she and her husband enjoyed the Palmetto State, they found it challenging to live there and care for family members with health issues back in Virginia. In 2019, they returned to Virginia and Peake soon took on a new role: state epidemiologist.

“The Office of Epidemiology serves as the backbone of communicable disease prevention and control,” she explains. “We create polices, manage surveillance and data systems, and develop procedures for the local health departments to utilize when they’re doing their investigation and surveillance.”

The office tracks more than 80 reportable conditions in Virginia. It is the largest office in the Virginia Department of Health in terms of staff.

Peake’s role prior to the COVID-19 global pandemic focused on leadership and guidance of the five divisions within her office. That changed in 2020. “Because of this emerging disease, we moved to an incident command system, and most of my days now are spent working on the COVID response,” she says. “There is new information that comes out every day, so we’re trying to understand that and then translate that into policy, procedures and guidance documents both for local health departments and our response in public health. We’re also making sure that we’re continuing to improve our surveillance and to get information out that helps people understand what’s going on and helps them in their decision-making.”

Throughout her career, Peake has been involved in several responses and emerging diseases, including Anthrax, H1N1, SARS and Ebola. That experience has been helpful in dealing with COVID-19, but she has noted one big difference with this new disease. “I have been surprised that public health and the decisions around it have become political,” she says. “In the past, when we had emerging conditions, it was a time when people could come together and really focus on how we prevent disease because it does take the whole community working together to respond successfully.”

One thing the COVID-19 response has in common with previous emerging diseases is the challenge of effective messaging. “Prevention and risk are very hard concepts for people to understand,” Peake says. “When a new risk emerges, there is often so much fear, and people’s reactions can be extreme. As the risk becomes more familiar, though, people often find it difficult to continue to take the steps needed to keep themselves and others healthy.  It takes a lot of work and ongoing messaging to the public.”

Looking ahead to the fall and winter, Peake is hopeful that the measures being taken now to reduce the spread of COVID-19 will be beneficial in reducing influenza activity and other conditions. “If we can practice respiratory etiquette and continue to utilize physical distancing and masks, I think that will help us,” she says. “I also think it is critical for people this year to get a flu shot because it is very challenging when you have diseases with similar symptoms to know what’s going on.”

Peake says that COVID-19 has provided some lessons and opportunities to improve on prevention and infection control to reduce the spread of this and future diseases, but there are still challenges, including testing and PPE shortages. “There’s still a lot of work to be done to hopefully develop a vaccine and make that available,” she explains. “Based on the information we have now, it appears we have a long way to go in this pandemic, and it’s important for us to remain vigilant.”

With no end in sight for the pandemic, Peake does her best to manage the stress of long workdays by spending time with her husband, talking to her grown children, and starting each day with yoga when she can.

She also finds inspiration in the team of public health employees she works with daily who work in a field she says is not often understood. “Public health has been more in the spotlight now, but I’m still not sure people understand all of the work that local health departments do and how critical they are to their communities,” Peake says. “Our frontline public health workers inspire me to keep going and they are serving their community in a really important way. They are key to a successful response in this pandemic.”