Public health management

Pandemic or panic? The technological approach to tackling public health incidents

For years experts around the world have been warning that it is not a question of whether there will be another severe influenza pandemic, but when[1]. In recent weeks these warnings have taken a big step towards becoming a reality, following the outbreak of influenza A (H1N1) — or 'swine flu' as it is better known.

Although the outbreak originated in Mexico, it has spread rapidly with confirmed cases across the globe. In April of this year, Dr Margaret Chan, Director General of the World Health Organization (WHO) issued a statement raising the pandemic alert level to five — meaning that a pandemic is thought imminent as a result of human-to-human transmission and presence in at least two countries in the WHO region. This is the second highest alert level before confirmation that a global pandemic is underway. The statement urged all countries to ‘immediately activate their pandemic preparedness plans’.

The consequences of a disease outbreak to public health is a genuine concern. By their nature, influenza viruses are notorious for rapid mutation and unpredictable behaviour. Dr Chan pointed out that "heightened surveillance, early detection and treatment of cases, and infection control in all health facilities" are "effective and essential measures" that can limit the rate of spread of infection.

But what role does technology have to play in pandemic preparedness? And how is it being used by the UK’s Government to monitor and manage the current situation?

Braced for impact

The threat of pandemic influenza needs to be treated with the same sense of urgency and planning afforded to other national security and public health threats — as the consequences can be equally as devastating. But, as a recent US report[2] recognises, the outbreak of pandemic influenza can be manageable if effective measures are taken to prepare in advance.

This level of preparation is essential because of the potential impact a pandemic outbreak can have and which to some degree we are already seeing — with the closure of schools and the additional pressure on both primary and secondary healthcare services.

Multi-channel access direct to people’s homes

In an emergency situation the usual routes to access healthcare are not always available and in a pandemic situation, healthcare resources that cope at other times may be overwhelmed.

Technology can deliver web and telephony-based self assessment and/or healthcare professional assessment, direct care, offer up-to-date advice and guidance and, where appropriate, authorisation for receipt of antiviral medicine treatment without the need for people to leave their homes.

Technology can also be used in a ‘command centre environment’. This helps to monitor the situation in real-time with the facility to rapidly change and update the instructions given out by websites and call operators who are in direct communication with the public and to exchange information with other relevant agencies.

Internet tools drive a more efficient management of resources and alleviate unnecessary pressure on emergency and primary healthcare services, leaving them to respond to those who need them most.

Technology’s role

Technology can be applied to localised outbreaks or trans-boundary threats. With telephone and online healthcare services, such as NHS Direct, already proving popular with the public as a first point of call for health advice and assistance, the UK is leading the way in demonstrating how technology can take us beyond getting ready to being prepared.

Internet tools have the potential to provide ubiquitous advice for the public, empowering them to make decisions about their own health but also linking them to healthcare professionals, who can carry out an appropriate assessment and offer up-to-date and consistent advice and information. This reduces public anxiety and helps contain the outbreak and minimise the risk.

Making the right tools available to support patients and healthcare professionals, as well as ensuring that there is the ability to collect and analyse information gathered, is an essential part of forward planning — and this is where technology can lend a hand.

Systems in practice

Bio surveillance technologies can be used to aid the recording and management of pandemics and other emergency response situations, including terrorist attacks. They have been designed to be used by national call centres like NHS Direct, NHS 24, and emergency pandemic services utilising thousands of support staff.

One of the important factors in containing the spread of infection is the delivery of effective and consistent information. Technology is an effective component in communicating with the public, offering advice to those who are at risk or infected or directing them to other sources of information.

Not only can such applications be used to advise callers on how to reduce the risk of becoming infected, they can also be used to get appropriate treatment to those already infected or advise them on how to avoid spreading the infection further.

The Department of Health and NHS Direct are already embracing such technology in the UK to support a multi-channel National Pandemic Flu Line Service. The service, due to go live in the Autumn, will provide web and telephony based assessment, direction of care, advice and guidance to the public in the event of an influenza or other public health incident.

Health Secretary Alan Johnson commented that "we have been preparing for the possibility of a pandemic for a number of years and the World Health Organization says we are among the most prepared countries in the world" [3].

It is hoped that the National Pandemic Flu Line will provide a means of managing and directing patients at the point of triage, while collating information to forecast the impact of an outbreak and enable the effective planning of resources.

Flu Line is designed to support over 7,000 call centre agents and up to 1.5 million web transactions per day at peak and interface to the Government’s system for managing the release of antiviral medicines to the public.

Patients exhibiting symptoms will be encouraged to self-care in their own home where appropriate, to both reduce the risk of spreading infection and to minimise pressure on primary care centres. These patients will be able to access antivirals through the National Flu Line service.

Meeting public demand

In an environment where savvy and engaged members of the public are increasingly looking to the Internet to assess their symptoms and seek health information, a familiarity with using technology for this purpose will make these interventions accessible and acceptable to a broad section of society, who might otherwise struggle to access the care and advice they need.

Unprecedented health and security incidents are, by their nature, unpredictable and we must be prepared for every eventuality and be ready to use new ways and means of managing the situation.

Whether technology is utilised to streamline symptom assessment or to manage a pandemic outbreak, access to credible health information via the Internet enables government and healthcare organisations to act at the right time and in the right way to health incidents. Preparation is everything — having the tools to react quickly and effectively to these situations can really make the difference between life and death.

Dr Jean Challiner, Clinical Solutions.

References

1. NHS Direct. Executive Summary. Pandemic FluLine Service
Board Meeting: 5 February 2008. (PDF File)
www.nhsdirect.nhs.uk/media.aspx?id=1033

2. US House Committee on Homeland Security. Getting Beyond Getting Ready for a Pandemic Influenza. January 2009. Available as a PDF file:
http://homeland.house.gov/SiteDocuments/20090114124322-85263.pdf

3. Quoted in ‘Government names swine flu ‘tsar’, BBC online, 06 May 2009

Resources

UK Health Protection Agency
www.hpa.org.uk/

NHS Direct — health advice and information for the public
www.nhsdirect.nhs.uk/

World Health Organization
www.who.int

WHO Influenza A(H1N1) web site
www.who.int/entity/csr/disease/swineflu/en/index.html

WHO guidance for Epidemic and Pandemic Alert and Response (EPR) — a complete list of WHO documents:
www.who.int/csr/disease/swineflu/guidance/en/index.html

EU Public Health — influenza news
http://ec.europa.eu/health/ph_threats/com/Influenza/novelflu_en.htm

US National Institute of Allergy and Infectious Disease, National Institutes for Health
http://www3.niaid.nih.gov/topics/Flu/