The Internet and the Flu

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While many around me were complaning that the WHO and various national health monitoring agencies hadn’t moved fast enough to stop the spread of the swine flu, I can’t help but think of the differences between the outbreak of SARS a couple of years ago and the current outbreak we are living through right now.

The differences are very encouraging, as some news outlets have been reporting. But amidst the more sensational headlines (my favorite: 2009: The New 1918, in reference to the 1918 outbreak of Spanish flu that killed between 70 to 100 million people worldwide), it is reassuring to see voices of reason starting to take over. Because when people panic (especially for no good reason), they do stupid things – like not wash their hands correctly and continuously – and that could be the most dangerous thing about this pandemic.

Which brings me to the topic of this post: the amazing development of Internet-based technologies in the last couple of years which are making their marks on this year’s epidemic.

From the CBC: Did pandemic-watchers miss the signs online?

On April 25, the World Health Organization declared a “public health emergency of international concern” after evidence that a new strain of swine flu had begun spreading from Mexico to other countries.

A day later, Veratect Corp., a Kirkland, Wash.-based company announced in a news release that it first detected and started monitoring the outbreak of respiratory illness in Mexico on April 6. That was more than two weeks before WHO issued its first alert on the outbreak.

This week, WHO declared it was too late to contain the disease and stop its spread. As of Friday afternoon, WHO had confirmed 365 cases of the disease in 13 countries around the world.

Could the spread of the virus have been stopped if public health groups had paid better attention online earlier?

“That’s the real question,” said Dr. Kumanan Wilson, an associate professor of medicine at the University of Ottawa and Ottawa Health Research Institute, who co-authored a recent article about online disease detection tools. The article, published in the Canadian Medical Association Journal in March, showed that there may have been early warning signs on the internet of Canada’s summer 2008 listeriosis outbreak.

Organizations like the World Health Organization have also been using electronic tools to monitor for outbreaks, Wilson said. They include the Global Public Health Intelligence Network, developed by Health Canada, which trolls the internet for news reports about diseases, as well as similar tools that are available to the public, such as:

  • ProMed, which is run by the Federation of American Scientists.
  • HealthMap, which is supported by, Google’s charitable arm.

Wilson said ultimately, public health officials would like to use such tools be able to spot emerging pandemics early enough to isolate affected populations and curb the spread of diseases.

In the case of swine flu, Wilson said, “We weren’t able to identify this early enough to effectively intervene.”

At the moment, he said, it isn’t clear if identification of potential pandemics at such an early stage will ever be possible, even with access to sophisticated online tools.

Earliest reports March 31, April 1

Wilson’s co-author on the listeriosis paper was John Brownstein, an assistant professor of pediatrics at Harvard University and former Montrealer who co-created the non-profit Health Map service. The tool mines over 20,000 websites to find disease reports, extracts the text and organizes the information by disease and location.

In fact, Health Map had received its earliest report about the Mexican outbreak on April 1, Brownstein said.

Veratect, one of a few companies in North America that track diseases and civil unrest online for paying clients such as World Vision, claims it tracked the first case of the disease a day earlier.

Brownstein said his team obviously should have been paying closer attention to the mysterious respiratory illness that had affected 60 per cent of people in La Gloria, a town in the Mexican state of Vera Cruz, but similar outbreaks are common worldwide. It’s hard to tell if such an outbreak will remain isolated or spread around the world, he added.

“There’s an information overload situation, where to decide which outbreak to respond to is very difficult.”

His organization does send daily emails to the Centres for Disease Control, the World Health Organization and other health organizations about disease outbreaks it detects, and the internet monitoring is improving, he said.

“The data we’re getting is earlier and earlier,” he said.

But it’s easy to see that public health organizations may have trouble dealing with the flood of reports they receive. (Read the rest of this interesting article here.)

So while we should continue being careful by washing our hands continuously and thoroughly, while we should be saddened by the deaths, we should also remember that this relatively benign epidemic is further proof that the world is but one country and we are slowly learning to adapt to it.

Oh, and this would be an opportune moment to give in to the Purell craze.

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