Managing disease outbreaks with information technology

The relatively benign yet extremely contagious norovirus has plagued the UK over the winter months. With the number of cases reported this year surpassing all other recent years (except 2002, which was the most severe season recorded and was associated with the emergence of a new antigenic virus type [1]), many hospitals have been struggling to cope. Some have been forced to close wards to new patients, due to the serious shortage of beds.

The Health Protection Agency (HPA) revealed that 1,922 laboratory samples were confirmed as norovirus during the last three months of 2007. It is estimated that the total number of people affected exceeds 2.8 million, or 1 million per month so far. The number of norovirus cases this year far exceeds all recent years, with the exception of 2002’s epidemic (see table 1 below).

Table 1. Norovirus laboratory reports from
England and Wales at the beginning of the
norovirus season

With estimates that noroviruses can cost the NHS in excess of £100 million per year in epidemic seasons[1], and the public being advised to stay away from hospitals and GP surgeries, how can we be better prepared to monitor, manage and limit an outbreak?

Pandemic or pandemonium

Although norovirus is a relatively benign disease, the recent outbreak has certainly raised questions concerning our ability as a nation to manage outbreaks. The threat of avian influenza to public health; unforeseen issues, such as terrorist attacks; and the chemical Polonium 210 recently found in areas around London, are also common concerns in today’s society. These all pose situations where one single health issue has the potential to affect a substantial proportion of the population.

The risk is so serious that governments around the world are investing time, resources and funding into planning and preparing for such an outbreak. Most governments have in place pandemic plans with alerts corresponding to the level of threat — the UK, for example, has four alert levels.

This level of preparation is essential because of the potential impact a pandemic outbreak can have upon society’s infrastructure. In the 20th century, the greatest influenza pandemic occurred during 1918–1919. It caused an estimated 40–50 million deaths world wide[2] and created a devastating impact on most countries affected, with many people too ill to maintain important services such as public transport and educational establishments.

Traditional healthcare no longer enough

In a pandemic situation, traditional access to healthcare is not always an option. Yet through services such as NHS Direct the public is becoming familiar and comfortable with using telephone-based access to healthcare and advice.

In fact, since the onset of this winter’s norovirus, NHS Direct has seen an increased number of calls from the public complaining of diarrhoea and vomiting symptoms[3]. This indicates that, in an epidemic situation where traditional healthcare is less accessible, the public would be encouraged to seek advice via these methods and informed of the most appropriate action by the call operator, depending upon the severity of their condition.

How technology can help

The spread of disease in an outbreak or pandemic situation is more containable if effective measures are taken to prepare for the onset. By providing the public with access to immediate clinical expertise, collecting and analysing information, and deploying the right resources at the right times, outbreaks, benign or otherwise, can be contained and the level of risk to the population minimised. Preparation is everything — having the tools to react quickly and effectively to these situations can really make the difference between life and death.

The role IT can play in monitoring and managing an outbreak is significant. Disease outbreaks spread quickly by nature, so it is imperative that an IT application has a significant impact on the containment and is able to operate under the constraints caused by the situation. The need for fast deployment to respond to patient demand is essential, as is the need for call operators to manage large numbers of calls. Equally important is the need for non-clinical call operators to take calls from the public, as clinicians may either be ill themselves or needed within the community.

An IT application, incorporating experienced scripted clinical advice and pathways, enables non-clinicians to deal with patient encounters and determine the most appropriate action based upon their answers to the system’s algorithms, set out by the healthcare provider or organisation.

Systems in practice

Bio-Surveillance technology, a system designed to aid the recording and management of pandemics and emergency response situations, can be used by national call centres like NHS Direct, NHS 24, and emergency pandemic services utilizing thousands of support staff.

Similarly the same system can be used by local government planning departments or health protection agencies to cope with locally contained emergency responses to floods or industrial accident type incidents. These applications enable quick deployment of helplines, providing a consistent approach to collecting information for decision making and prioritisation of resource allocation, while providing advice and educational material to the public or instructions to support staff and other agencies.

One of the important factors in containing the spread of infection is the delivery of effective and consistent information. Bio-Surveillance technology is an effective component in communicating with the public and offering advice to those who are at risk or infected. Not only can the technology be used to advise callers on how to reduce the risk of becoming infected, it can also be used to get appropriate treatment to those already infected or advise them on how to avoid spreading the infection further.

Exercise Cumpston

In 2006, Australia’s health and emergency services participated in the largest health exercise ever held in the country, in order to test its planned preparations in the event of a pandemic influenza outbreak. The project, named Exercise Cumpston, simulated the arrival of an international flight carrying sick passengers, the emergence of the pandemic in the community and the trial of the health system’s capacity to contain and manage a pandemic.

There were a total of 1,500 participants and control staff in the exercise, which included a diverse range of government and non-government agencies and their private sector partners. The Bio-Surveillance application, from Clinical Solutions in this instance, was used to first determine if a person had been infected or exposed and then to direct them to the most appropriate point of care. From the data collected by the application, patterns could be determined of virus origination and spread.

This technology has been designed to respond to incidents in real time. This includes changing mandatory information required and advice or interventions that service operators need to give. Depending on the nature of the required changes, this can be a matter of minutes or a couple of hours. In the case of major incidents, it is likely that health organisations will already have defined the content of the service (questions, answers and interventions) in advance as part of their advance planning process.

Bio-Surveillance technology played a significant role at the heart of Exercise Cumpston as there was the need to collect and analyse data relating to the number of carriers of the disease, the severity of the symptoms and the location of each participant.

Peace of mind

While Bio-Surveillance technologies cannot provide clinical solutions for tackling pandemic outbreaks, they can provide a tool for quickly and effectively analysing the spread of symptoms and a means of communicating health advice to those affected. The use of technology offers a consistent approach to assessing symptoms and a means of reducing the risk of error as emotional factors are removed from the process.

Bio-Surveillance technologies are becoming a vital component of the strategy for communicating with the public, offering advice to those who are at risk or infected during pandemic situations. Being better prepared to monitor, manage and prevent outbreaks developing into pandemics will help the press, service operators and the public at large to be more confident that everything that can be done is being done.

Dr Dennis McShane, Chief Medical Officer, Clinical Solutions.

References

1. Health Protection Agency.
www.hpa.org.uk/hpr/archives/2007/news2007/news5107.htm#noro

2. The World Health Organization. 07 June 2007. www.who.int/csr/disease/influenza/pandemic/en/

3. NHS Direct.  www.nhsdirect.co.uk