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 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, 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 Nov. 9-13.

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, Fla., identified anthrax in a supermarket tabloid photo editor named Bob Stevens.

"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.

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