ALBANY, N.Y., Oct. 21 (UPI) -- Part 16 of a continuing series. If a bird-flu epidemic occurred in the United States, some health departments would continue to monitor it using postcards -- a longstanding practice -- because most doctors and hospitals have not yet employed health information technology.
"Currently, much disease reporting is through the telephone, fax and postcards. It's gotten a little bit better, and we're on the cusp of actually being able to see the blips (using computers) of pharmacy sales, rashes, respiratory illness -- a whole set of factors," said Janet Marchibroda, head of eHealth Initiative, a non-profit organization in Washington, D.C., that seeks to improve the quality, safety and efficiency of healthcare through information.
"It was by following (the anthrax attacks in 2001) that it was made a priority to be able to detect bioterrorism," Marchibroda told United Press International. "This was the beginning of our organization -- the same infrastructure and information needed for health IT are the same in dealing with an epidemic."
E-mail is a little better than fax, she said, but it is not used regularly for the transmission of data, and data are the problem -- how many people with fever, how many coughs, and so on.
"It's hard to pull out the symptoms that could be bird flu using paper files," Marchibroda said. "You really can't do that without health IT systems -- especially in hospitals. However, if the whole country was set up with health-exchange information, the way Indianapolis is -- 70 percent of physicians' offices are wired and they can exchange laboratory and pharmacy data -- you can look for weird blips (and) see clusters, which is important in epidemics and in a bioterrorist attack."
Detecting and tracking the spread of a virus is critical in addressing a global health threat, according to the World Health Organization.
WHO officials are seeing small and highly localized clusters of human-to-human transmission of bird flu, suggesting the virus is not yet well adapted to humans, but if a larger cluster of human-to-human bird flu appears, it will suggest the virus is becoming increasingly better adapted to humans. This development may not signify a substantial pandemic risk, but it will need to be tracked carefully for its rate of transmission, geographical location and severity of the illness.
The Spanish Flu in 1918 killed up to 50 million people worldwide. In the United States, where almost 700,000 died, health departments tracked the spread of the killer flu using postcards. Doctors and hospitals were required to send a postcard each day with the number of people who were treated for the influenza and who died. Health officials could track the disease -- influenza usually occurs in a bell-shaped curve -- and separate people who were sick from others to cut down the spread of the flu.
Today, the Centers for Disease Control and Prevention in Atlanta tracks the yearly regular flu with approximately 1,000 healthcare providers around the country that report the total number of patients seen and the number of those patients with influenza-like illness each week with fever plus a cough and/or a sore throat -- by age group. The percentage of patient visits to sentinel providers for influenza-like illness reported each week is weighted on the basis of state population and is compared each week with the national baseline of 2.2 percent.
Some public-health experts, however, think tracking bird flu needs to be done hospital by hospital and in real time.
"Public-health officials at all levels -- from local to worldwide -- would need to stay on top of tracking (bird flu)," said James D. McGlothlin of the School of Health Sciences at Purdue University in West Lafayette, Ind. "Any person with a flu that failed to improve within a week should be brought to the attention of a physician, who could evaluate the illness and have the patient tested for the H5N1 virus and take the necessary steps, such as isolating the person to prevent the virus's spread to a larger population."
Quarantines, managed by the military, which have been suggested by President George W. Bush, would be the last option, McGlothlin said, but quarantines are not necessarily a good option.
"We need to be able to respond immediately with the right people, at the right time, with the right plan," he said.
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Alex Cukan covers healthcare technology for UPI. E-mail: [email protected]
