Creative Way to Detect Germ Attacks
— -- Using Creative Tactic to Detect Germ Attacks
N E W Y O R K, Nov. 4 — Public health officials have developed an oddinterest lately in the mundane and arcane.
Epidemiologists are tracking orange juice sales at the localSafeway and poring over school attendance data. They're mappingevery case of the sniffles they can find and watching surveillancevideos 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 healthcommissioner's worst nightmare — a massive biological attack. So inthe last few years, an increasing number of health departments havestarted collecting electronic data from hospital emergency rooms,pharmacies and other sources in an effort to gauge the overalllevel 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 diseasediagnoses. In September, public health officials from around thecountry met at the New York Academy of Medicine to explore thepotential of using syndromic surveillance as part of a bioterroralarm system. The conference was organized by the New York Cityhealth department with help from the Centers for Disease Controland funding from the Sloan Foundation.
The new disease-tracking approach is also on the agenda at theAmerican Public Health Association annual meeting in PhiladelphiaNov. 9-13.
Last year's anthrax letter campaign was just "a tragicdry-run," Minnesota state epidemiologist Michael Osterholm toldhis colleagues on the first morning of the conference.
"Do not under any circumstances be surprised when the next shoedrops," Osterholm admonished. "It will drop."
And more than a year after the Sept. 11 attacks, the nationremains woefully vulnerable to terrorist attacks of all kinds, apanel on homeland security reported recently.
If it were to provide early warning of a bioterror attack,syndromic surveillance might avert massive casualties. Even some ofthe deadliest bioterror agents — including anthrax, plague andsmallpox — can be treated successfully if they are diagnosed earlyenough. But they also progress quickly from mild symptoms toserious illness to death, so hours count.
"There is the potential of a huge benefit if we really do getearly detection of a large bioterror event out of this," saidFarzad Mostashari, an assistant commissioner at the New York Cityhealth department.
Traditionally, health departments have relied on astute doctorsto identify bioterror attacks by diagnosis. That's how last fall'sattacks came to light — Dr. Larry M. Bush, a physician at JFKMedical Center in Atlantis, Fla., identified anthrax in asupermarket tabloid photo editor named Bob Stevens.
"We don't pretend that the technology can replace man or thatthis is the answer to everything," said Mostashari.
But doctors may not recognize such rare diseases as tularemia, Qfever or bubonic plague — all potential bioterror agents. And onediagnosis would not tell public health officials very much aboutthe scope, geographic location or timing of an attack. So tosupplement the eyes and ears of individual physicians, some publichealth departments now monitor everything from emergency roomvisits, 911 calls and doctor visits to school absenteeism and salesof cough syrup.
Public health has enjoyed a badly needed cash infusion in theyear since the World Trade Center and anthrax attacks. The Centersfor Disease Control and Prevention got $1.1 billion from Congressthis year to beef up bioterrorism defense. It is hard to sayexactly how much of that money is going to surveillance, but manyexperts believe spending a sizable chunk of it on warning systemswould be a good idea.
"For a long time it was very hard to get people to listen whenyou talked about public health surveillance," said MargaretHamburg, vice president for biological programs at the NuclearThreat Initiative, a Washington, D.C., think tank. "Surveillancesimply was not sexy and it was very poorly understood."
