Public Health and "tweet" timely data

BY HUMAYUN J. CHAUDHRY
May 20, 2009

As medical residents 20 years ago, when we responded to a nurse's call that a patient was short of breath, we would engage in "elevator thoughts" - sorting out the possible reasons and planning a management strategy in the brief solitude of the hospital elevator - before rushing to the bedside.

Fast-forward to last month when I learned in an electronic "tweet" about the first death in the United States attributed to swine flu. A simple click on the Internet link accompanying that message gave me detailed information about the circumstances surrounding the death.

Over the past several weeks, my BlackBerry, Bluetooth, laptop and wireless card have worked countless hours to keep me informed and in touch with colleagues in the county, throughout the state and across the country.

Even on my first day on the job more than two years ago, I was pleasantly surprised by the advanced technology (satellite phones, laptops and other communications equipment) that we had on hand. Much of that was in place because of public health emergency preparedness funds that became available after 9/11 - the same funds to county health departments that were cut 15 percent earlier this year by New York State.

Access to timely data and the ability to rapidly transmit that information to the public - whether managing a food-borne outbreak, a mosquito-borne illness, or a potential pandemic with swine flu - is critical for health departments.

It wasn't until this past month, however, with swine flu grabbing our full attention, that I have fully appreciated how all the gadgetry can benefit our public health response.

Some examples:

Anytime an area of Suffolk County has an increase in 911 calls for fever, cough or other respiratory illness beyond a set threshold number, I receive an electronic alert that instantly tells me the number of such calls, the times they were made and the hospitals where the individuals were taken.

In meetings earlier this month with officials from the Deer Park school district, which had three confirmed cases of swine flu and closed down for a week based on federal guidance in place at the time, district administrators were quickly able to access their own password-protected Web site for vital information about their students - including absenteeism and parental contact information.

Text messages to health officials in neighboring counties are responded to almost instantly. Dr. Richard Daines, the state's health commissioner, and I have communicated well into the night via BlackBerry.

The U.S. Centers for Disease Control and Prevention, as part of a national effort to keep the public informed about swine flu, has been using social networking sites like Facebook and MySpace to communicate updated information about swine flu. Its Twitter link is free and available to anyone with a cell phone or Internet access.

While many teenagers and young adults use these technologies for socialization and idle chatter, the same wizardry enables all of us in public health to instantly communicate back and forth and with others. This ensures not only instant access but immediate sharing of new information, critical to safeguarding the public's health.

That's not to say there aren't challenges. Not everyone wants to Twitter or has a BlackBerry, for example, and any funding cuts in our ability to purchase or maintain technology seem particularly ill-timed.

Sometimes, as we saw on May 5, public health messages are conveyed so rapidly that they trip over one another, as when the CDC's acting director, Richard Besser, announced at a press conference that schools with confirmed cases of swine flu could re-open. Those listening to his public Webcast learned the news before many local and state health departments had been formally notified.

Of course, decisions made face-to-face are still favored over those made by BlackBerry, especially when they are of high importance - as with school closure decisions. Such discussions also allow an exchange of nuance and body language - the latter impossible with texting alone.

But on balance, technological advances incorporated into our public health system, whether through instant messaging or surveillance software, provide reassurance to the patients and public we serve. And when I now take that long, slow elevator ride, I am amazed how much information I can get from a device the size of a wallet before those elevator doors open.