- Unquestionably, there are a lot of positive changes taking
place...such as those mentioned below. However, what do we do when we
recognize that an event has occurred...and we have patients showing up
are local hospital ERs with infectious diseases?
-
- As was the case in Florida a couple of weeks ago, and
in Brooklyn, New York back in July, a total hospital lockdown occurred
pending diagnosis of patient smallpox. We were fortunate that the paitents
in both of those cases did not have the disease. But what if they had
been so infected? How can the flow of paitents with an infectious disease,
as well as regular hospital patients, be cared for if a hospital is in
lockdown?
-
- Clearly, we need to combine the enhanced epidemiological
tracking with a plan to treat infectious diseases as well as patients who
were victims of chemical or nuclear weapons. My plan to set up "isocenters"
really needs to be considered.
-
- An Isocenter would be a facility that would treat ONLY
victims of infectious diseases, chemical weapons or nuclear radiation.
These facilities would be set up throughout the US and then put on sealed
standby, ready to take active cases if needed. I suggest that each major
city (at minimum) would maintain an activated Isocenter Emergency Department
and that dispatchers and first responders would be given a criteria of
symptoms that would mandate transport of a patient in a biosafety ambulence
to nearest Isocenter which would activate and receive patients. This would
ensure that local hospitals would not be locked down and the suspected
infectious disease patient would be treated in an isolated, controllable
environment.
-
- Many towns and cities have existing resources of VA Hospitals,
closed military bases as well as real estate (apartment complexes, warehouses
etc) that could be set up as an Isocenter. If we begin now, before an
event occurs, we can construct such facilities and have them ready when
the need arises. I hope that the enhanced epidemiological surveillance
will combine with Isocenters (facilities that handle Biolevel 4 pathogen
diseases) and will save lives.
-
- If you would like further information on my concept of
Isocenters or information on staffing infrastructure, please contact me
at: dr_p_doyle@msn.com
-
- Thank you, Patricia Doyle
-
- Health Departments Aim To Spot Bioterror
-
-
- From Stephen M. Apatow <s.m.apatow@humanitarian.net>
Source: AP [edited] 11-6-02
-
- Public health officials have developed an odd interest
lately in the mundane and arcane.
-
- Epidemiologists are tracking orange juice sales at the
local Safeway and poring over school attendance data. They're mapping every
case of the sniffles they can find and watching surveillance videos to
count how many times people sneeze.
-
- The idea is that a sudden spike in everyday aches, pains,
sniffles, and coughs could signal the earliest stages of a health commissioner's
worst nightmare -- a massive biological attack. So in the last few years,
an increasing number of health departments have started collecting electronic
data from hospital emergency rooms, pharmacies, and other sources in an
effort to gauge the overall level of illness in the population.
-
- Epidemiologists call their new strategy syndromic surveillance,
because it looks for increases in clusters of symptoms ("syndromes"
in medical jargon) rather than particular disease diagnoses. In September
2002, public health officials from around the country met at the New York
Academy of Medicine to explore the potential of using syndromic surveillance
as part of a bioterror alarm system. The conference was organized by the
New York City health department with help from the Centers for Disease
Control and funding from the Sloan Foundation.
-
- The new disease-tracking approach is also on the agenda
at the American Public Health Association annual meeting in Philadelphia
9-13 Nov 2002.
-
- Last year's anthrax letter campaign was just "a
tragic dry-run," Minnesota state epidemiologist Michael Osterholm
told his colleagues on the first morning of the conference. "Do not
under any circumstances be surprised when the next shoe drops," Osterholm
admonished. "It will drop."
-
- And more than a year after the Sept. 11 attacks, the
nation remains woefully vulnerable to terrorist attacks of all kinds, a
panel on homeland security reported recently.
-
- If it were to provide early warning of a bioterror attack,
syndromic surveillance might avert massive casualties. Even some of the
deadliest bioterror agents -- including anthrax, plague and smallpox --
can be treated successfully if they are diagnosed early enough. But they
also progress quickly from mild symptoms to serious illness to death, so
hours count.
-
- "There is the potential of a huge benefit if we
really do get early detection of a large bioterror event out of this,"
said Farzad Mostashari, an assistant commissioner at the New York City
health department.
-
- Traditionally, health departments have relied on astute
doctors to identify bioterror attacks by diagnosis. That's how last fall's
attacks came to light; Dr. Larry M. Bush, a physician at JFK Medical Center
in Atlantis, Florida, identified anthrax infection in a supermarket tabloid
photo editor.
-
- "We don't pretend that the technology can replace
man or that this is the answer to everything," said Mostashari.
-
- But doctors may not recognize such rare diseases as tularemia,
Q fever, or bubonic plague -- all potential bioterror agents. And one diagnosis
would not tell public health officials very much about the scope, geographic
location, or timing of an attack. So to supplement the eyes and ears of
individual physicians, some public health departments now monitor everything
from emergency room visits, 911 calls, and doctor visits to school absenteeism
and sales of cough syrup.
-
- Public health has enjoyed a badly needed cash infusion
in the year since the World Trade Center and anthrax attacks. The Centers
for Disease Control and Prevention got $1.1 billion from Congress this
year to beef up bioterrorism defense. It is hard to say exactly how much
of that money is going to surveillance, but many experts believe spending
a sizable chunk of it on warning systems would be a good idea.
-
- "For a long time it was very hard to get people
to listen when you talked about public health surveillance," said
Margaret Hamburg, vice president for biological programs at the Nuclear
Threat Initiative, a Washington, D.C., think tank. "Surveillance simply
was not sexy and it was very poorly understood."
-
- Until recently, some researchers were skeptical that
anything so apparently trivial as cough syrup sales could indicate a significant
jump in illness. But researchers have shown that at least with the annual
flu season, there are a wealth of indicators that people are getting sick.
-
- Elaine Newton, a graduate student at Carnegie Mellon
University, has done studies showing that orange juice and paper tissue
sales increase at the onset of flu season. She has also found that Internet
consumer health web sites dealing with the flu get more hits a few days
before a flu outbreak is officially announced.
-
- Now Newton is exploring the seemingly far-fetched idea
of using surveillance camera footage of public places to gauge the health
of the population, perhaps even by counting coughs and sneezes.
-
- Such notions naturally raise the issue of privacy. The
current systems do not collect names or other identifying information,
but Carnegie Mellon computer scientist Latanya Sweeney said anybody who
really wanted to identify a person would probably be able to do so by combining
data from the bioterror system with facts culled from voter rolls or some
other public database.
-
- New York has had a system since 1999. It analyzes information
from hospital emergency rooms, the 911 system, and ambulance dispatches
for sudden increases. The system also collects sales data from city drugstores
and absentee statistics from employers and schools as supplementary information.
-
- Since June 2001, Seattle's public health department has
analyzed reports from 3 emergency rooms and 11 primary care clinics. The
Seattle system also monitors 911 dispatches, which are made available via
the Internet by the city's fire department.
-
- Baltimore even collects information on dog and cat deaths
from the city's animal control department, and keeps track of school absenteeism
and over-the-counter cold medicine sales.
-
- A system in western Pennsylvania collects information
on every patient who passes through the doors of 21 hospital emergency
departments. It records the age, gender, home ZIP code, time of admission,
and chief complaint of each patient, and looks for sudden increases in
respiratory illness and other symptoms that might indicate a bioterror
attack. A version of the Pennsylvania system was also set up in Utah for
the 2002 Winter Olympics, and has been operating there ever since.
-
- Monitoring major public events for bioterrorism has become
a challenging subspecialty for designers of these early warning systems.
In addition to the 2002 Winter Olympics, systems have been set up for the
1999 World Trade Organization meeting in Seattle, both the Democratic and
Republican party conventions in 2000 and the 2001 World Series.
-
- In October 2002 the Centers for Disease Control and Prevention
awarded a $1.2 million grant to Harvard University researchers to begin
developing a national warning system that automatically collects information
on the number of patients with flu-like symptoms, strange rashes, and other
possible symptoms of bioterrorism.
-
- The New York health department knows its surveillance
system works because it goes off all the time. A sudden increase in rashes
at a particularly busy emergency room is much more likely to be a random
uptick than a smallpox attack. A rise in fevers and coughs during November
almost certainly means "flu," not "anthrax."
-
- For example, New York's system issued an alert the day
American Airlines Flight 587 crashed on takeoff from JFK airport, 2 months
after the World Trade Center attacks. The 2 hospitals nearest to the crash
site were reporting an unusually high number of patients with respiratory
problems, a possible indicator of an attack with anthrax or several other
bioterror agents. When investigators checked with the hospitals, they
discovered that the increase was due to a handful of factors, some related
to the plane crash and some incidental. There was one firefighter who had
smoke inhalation from responding to the crash, 2 cases of flu, 3 asthma
attacks, 2 people complaining of chest pain, and one person who appeared
upon examination to be having an anxiety attack.
-
- "We didn't really think there was a bioterrorism
attack," said Mostashari, who is credited with setting up the New
York surveillance system. Even so, he added, every suspicious pattern
has to be investigated or the system won't work.
-
- "We do need something to give us a sense of the
pulse of the city," said Marcelle Layton, an assistant commissioner
at the New York Department of Health and Mental Hygiene.
-
- For all its sensitivity, New York's system did not detect
the anthrax attacks last fall. Layton and her colleagues do not consider
that a problem, however, because the system is designed to detect major
airborne bioterror attacks. Last year's mail attacks were so limited that
only one of the 7 New Yorkers who contracted skin anthrax from contaminated
letters even visited an emergency room.
-
- [By: Matt Crenson]
-
- The following information sources provide additional
information on the subject matter:
-
- 1. CDC:MMWR: September 11, 2002 / 51(Special Issue);13-15
Syndromic Surveillance for Bioterrorism Following the Attacks on the World
Trade Center --- New York City, 2001 <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm51SPa5.htm>
-
- 2. DOD:GEIS: Syndromic Surveillance: A New Way to Track
Emerging Infectious Diseases <http://www.geis.ha.osd.mil/GEIS/SurveillanceActivities/ESSENCE/ESSENCE.asp>
-
- -- Stephen M. Apatow Humanitarian Resource Institute
Biodefense Reference Library <http://www.humanitarian.net/biodefense>
<s.m.apatow@humanitarian.net>
-
- [ProMED-mail has covered 2 of the newer syndromic surveillance
projects in prior postings this year under this same thread (Disease surveillance:
enchancement) and subscribers are referred to these posts for detailed
coverage of the 2 systems: the RSVP system (Rapid Syndrome Validation Project)
and the RODS system (Real-Time Outbreak and Disease Surveillance).
-
- This news article gives a nice overview of some of the
projects presented at the National Syndromic Surveillance Conference in
September 2002. Having attended this conference, one of the messages I
walked away with was that at the present "state of the art" of
syndromic surveillance, with respect to its value in early detection of
an intentional biologic event, we are still very dependent upon the astute
clinician(s) evaluating the first patient(s) to get the appropriate diagnostic
tests to confirm the responsible organism. The value of the various systems
to date has been to identify increases in illness patterns (such as influenza-like-illness)
a few weeks before the traditional surveillance systems have (the "pneumonia
and influenza" systems) data supporting the existence of an outbreak.
The intentional anthrax incident was first identified by an astute clinician
in Florida. Several of the cutaneous cases had dates of onset preceding
the identification of the systemic anthrax case in Florida, but only after
that case was identified was the diagnosis of anthrax considered. The
strength of these systems is that they allow for real-time monitoring of
the order of magnitude of the problem once identified, and the geographic
spread, again, once the illness is identified.
-
- Many of the presentations from the National Syndromic
Surveillance Conference held at the New York Academy of Medicine are available
online. <http://www.nyam.org/events/syndromicconference/agenda.shtml>
-
- In addition, as mentioned in the previous posting in
this thread, there were several presentations related to enhanced surveillance
systems and real-time reporting presented at the International Conference
on Emerging Infectious Diseases 2002. Readers are encouraged to view the
webcasts of these presentations: <http://www.cdc.gov/iceid/webcast/a-z_topics.htm#surveillance_systems>
- Mod.MPP]
-
- [see also: Disease surveillance: enhancement (02) 20020708.4696
Disease surveillance: enhancement 20020128.3424 Bioterrorism: WHO
guidance 20020126.3401 1998 ---- International health regulations,
revisions 19980124.0177] ...........................mpp/pg/mpp
-
-
- Patricia A. Doyle, PhD Please visit my "Emerging
Diseases" message board at: http://www.clickitnews.com/emergingdiseases/index.shtml
Zhan le Devlesa tai sastimasa Go with God and in Good Health
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