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Last Updated

15 Nov 2002

Source: Associate Press, January 6, 2002.

Bioterror fears prod warning systems

NEW YORK (AP) -- Nowadays, hospital workers tracking disease outbreaks send data over a system cobbled from a jumble of telephones, faxes and computers that can't talk to each other.

With the anthrax mailings jolting experts to the inefficiency of these methods, movements are afoot to try to establish a single nationwide early-warning network.

"In some cases we're talking about installing computers in places for the first time. They're still reporting by paper and pencil," said Elin Gursky of the Center for Civilian Biodefense Strategies at Johns Hopkins University.

At the moment, the United States has no single nationwide system to alert health and emergency officials of a fast-moving epidemic or biological attack.

The release of a pathogen -- such as pneumonic plague or anthrax -- might go unnoticed until hospital patients start showing similar symptoms that could resemble common flu.

If such an agent were released at, say, a professional convention, delegates could fly home before falling ill. With victims spread across the country, tying them to a common event could take days, said Ben Venzke, chief executive of Virginia-based IntelCenter, a private firm focused on terrorism.

"They all get symptoms. But only one or two present them at the same hospital," Venzke said. "It's going to be very hard to understand that it's a big problem. There isn't a good system to share that kind of information."

In Colorado in 2000, participants in a bioterrorism response drill found their biggest problems dealt with sharing information about a mock plague epidemic that "killed" more than 400 virtual victims.

'21st century technology' needed

For now, the focus is on improving networking technology in the 3,000 federal, state and local public health offices and labs, linchpins of testing and information dissemination. The labs have been notoriously underfunded, experts say. Some even lack computers and send disease reports by mail.

"We have hospitals doing hand-tallies of rashes and unexplained fevers. A lot of this is done on paper," Gursky said. "We're talking about basic processes that we have to expose to 21st century technology."

Experts who toil at the intersection of health and information technology say the answer should be a universal network linking hospital computers that store patient data with machines at state health department offices, as well as the federal Centers for Disease Control and Prevention -- and perhaps police, emergency responders and even the military.

The network should include the capability to trigger automatic warnings of events that appear related to a biological attack. This could mean a leap in respiratory illness in a city, a spate of flu symptoms, or even a run on Pepto Bismol.

A few existing warning and surveillance networks are being built, but none yet has the nationwide reach needed to serve as an official national emergency channel, similar to the U.S. Civil Defense radio broadcast channel used in the 1950s and 1960s.

The CDC's Health Alert Network, a communications backbone linking public health departments in 37 states to CDC headquarters in Atlanta, is being expanded nationwide. But the system, still in its early stages, does not link to individual hospitals -- or link hospitals to each other. Nor does it contain a real-time database or automated alert system.

The CDC network aims to ensure that all health departments have the Internet access required to send and receive alerts on disease outbreaks and other information.

"It isn't direct or fast enough," Gursky said. "If you really want to alert a community, you need to build not just vertical, but horizontal information flows."

Gursky and others say the CDC is also slowed by its dependent relationship with state health departments.

The CDC is also building out its National Electronic Disease Surveillance System, an Internet-linked database network. The system, which is not yet functioning, is supposed to track emerging outbreaks by allowing analysts to search and map disease reports and lab results provided by state and local health departments.

The CDC has funds to connect all states to the surveillance system in 2002, said Dr. Claire Broome, a CDC information systems adviser.

Reporting not always a priority

Another system, overseen by the Air Force, is already in place in some two dozen military and civilian hospitals.

That network, called the Lightweight Epidemiology Advanced Detection and Emergency Response System -- better known as LEADERS -- can send fast, automated alerts by scanning electronic records for clues to a disease outbreak. Emergency responders get alert messages on pagers, cell phones or e-mail accounts.

But LEADERS has its drawbacks.

It requires health officials to fill out an additional form, rather than sucking data directly from an existing computerized system.

"Getting health care providers to report is a difficult thing to do. If there's a doctor dealing with people bleeding and dying, it isn't something they make a priority," said Dr. Tracee Treadwell, an epidemiologist who heads the CDC's bioterrorism surveillance efforts.

And although its proponents say LEADERS is the ideal platform for a nationwide alert system, Treadwell said it is more useful for "drop-in surveillance" -- monitoring an event for evidence of a bioterrorist attack.

It saw use in New York City after the September 11 terrorist attack, as well as at last year's Super Bowl in Tampa and the 2001 World Series games in Phoenix. The system will be used to monitor health data during the 2002 Olympics in Salt Lake City, said Oracle Corp.'s Brian Jones, who oversaw creation of its database.

Since October, military think-tank RAND has hosted talks aimed at creating a national bioterror warning system that would go far beyond current networks. The system would enable communication among disparate health care computer systems that currently don't talk to each other. It would also tie them to law enforcers, emergency workers and even the military.

The recent anthrax mailings prompted a flurry of federal funds aimed at bioterror preparedness and upgrading the country's early warning system. Last month, Congress passed a $3 billion bioterrorism bill with about half its funding earmarked for public health labs and the CDC.

"It would be difficult and pompous for me to say that we are well prepared," said the CDC's Treadwell. "Do I think that if something happens we'll know about it tomorrow? Maybe. Probably."