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Worries over threats such as anthrax and SARS plague hospital administrators and public health officials. A nationwide system for tracking such incidents is in the works. 
As director of Emergency Services for William Beaumont Hospital in suburban Detroit, Val Gokenbach spends most of her days thinking about the unthinkable. For the last decade, she has developed ways for hospitals to manage bioterror threats and epidemics. Thanks to e-mailed alerts that keep her up-to-date on emerging threats, careful planning communicated to every member of Beaumont's staff, and "common sense," Gokenbach says, Beaumont is as well prepared as it can be to deal with threats to public health—from isolated cases of the West Nile virus to a full-bore bioterror attack that could affect thousands. So, in late March, when Beaumont admitted seven patients who had demonstrated symptoms of SARS—the infectious disease known as severe acute respiratory syndrome, which at last count had claimed more than 700 lives, according to the World Health Organization—Gokenbach and her team were ready. The patients were immediately isolated and carefully monitored until they proved to be infected with a far less threatening virus. "That brought home the fact that it's important to stay on top of information in order to be able to respond appropriately," Gokenbach says. "Had we not been carefully watching SARS right from the start, and had those patients been SARS-infected, we could have easily had an outbreak here." Tech-Assisted Tracking Like many other hospital administrators, Gokenbach relies on the dozen or so e-mails she receives daily from the local public health center for the latest news about epidemics and other threats. The center passes along information it receives from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) as well as regional updates. Gokenbach forwards the alerts to appropriate Beaumont personnel. Besides acting as a clearinghouse for the official alerts from health departments, laboratories, and government agencies, the WHO's Global Public Health Intelligence Network continually scours the Internet for hard information and anecdotal evidence about possible epidemic activity, according to the WHO Web site. Each weekday morning, the reports and rumors are reviewed and verified by the WHO's Global Outbreak Alert and Response team, which records and tracks the data and then shares it with Outbreak Verification List subscribers. The WHO credits the efforts of an international team of epidemiologists for helping stem the spread of SARS. The WHO-led crisis team contributed patient histories as well as test and treatment results to a private Web site so the scientists could learn from each other. As a result, just seven weeks after the disease began to spread worldwide, SARS was identified and named and its genome was mapped, according to the WHO's Web site. By comparison, as medical history attests, identifying the AIDS virus took three years, and mapping its genome took nearly two more. "It was a beautiful example of what science can do when scientists work together," says Dr. Wise Young, director of the W.M. Keck Center for Collaborative Neuroscience at Rutgers University. Young's lab has been instrumental in developing ways for scientists to share data. "We've come a long way. But we need to develop more, better, and faster ways to share information and work together." Young says that projects such as a national, CDC-funded bioterrorism syndromic surveillance demonstration program can help immeasurably in controlling future public health threats. In October 2002, the CDC awarded a grant of $1.2 million to a consortium of medical providers to develop the surveillance system, designed to allow government agencies, healthcare organizations, and research faculties to track potential attacks. The goal is to develop standard reporting protocols that all institutions can use and to facilitate participation in the network by health plans and medical groups that track "real-time, encounter-level" information, according to Harvard Medical School, a consortium member. The system is still being assembled, but it appears likely that hospitals will connect to state databases via the Web or be provided with software that enables access. A Nationwide System If developed as planned, the system will be capable of quickly sweeping 20 million patient records across all 50 states, looking for clusters of symptoms associated with bioterror agents, according to a Harvard Medical School statement. Similar systems in use by four consortium members—Harvard Pilgrim Health Care, Harvard Vanguard Medical Associates, Minnesota-based HealthPartners Research Foundation, and Kaiser Permanente of Colorado—do a daily scan of patient complaints and diagnosis codes. The systems then search for symptoms consistent with exposure to bioterror agents such as upper and lower respiratory illnesses, rashes, fevers, neurologic events, and sepsis. The results are compared with historical records to identify spikes or geographic clustering. Finally, the data is sorted by neighborhood to determine if numerous reported illnesses are coming from one particular town or medical facility. The system will not share information about individual patients, according to Harvard. The objective is to track illness patterns regionally and locally. The prospect of an inclusive bioterror and infectious disease tracker delights Gokenbach. "For such systems to be useful, everyone has to be able to easily
access the information and contribute data," she says. "But there's
no one tracking program that suits everyone's needs, abilities, and
computer systems now. Collecting and sharing health information
internationally is something that absolutely has to be done—and
done soon. It will save lives."
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