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Last Updated

13 Dec 2002

Source: Wall Street Journal, February 5, 2002.


Early-Warning Bioterror Research Puts Pittsburgh on Bush's Itinerary


PITTSBURGH -- In the event of a bioterrorism attack, early detection could save thousands of lives.

That realization has set off a stampede to develop technology for early-warning systems, as well as to snare funds earmarked in the president's budget for the fight against bioterrorism. President Bush, visiting here to push for increased funding for homeland security, will inspect a system under development for 2-1/2 years at the University of Pittsburgh.

The system, which can set off a beeper if there is a surge in respiratory distress and skin rashes in dozens of hospitals in western Pennsylvania, is being installed in Utah ahead of the Winter Olympics. Olympic officials, sensitive to bioterrorism risks, already have installed monitors to check the air for potentially dangerous substances.

The nation's inability to respond quickly to biological weapons was highlighted by the anthrax attacks last fall, in which officials seemed to respond slowly to confirmed cases of infection, even as deaths were reported. Up until then, most Americans had never heard of anthrax or considered the threat of bioterrorism urgent. But reports of random individuals dying of anthrax exposure created a near hysteria over what the administration was doing to counter and prepare for further threats.

Hospitals, for the most part, can detect an increase of certain ailments. The problem is pinpointing trends early and notifying health officials. Doctors in general are expected to notify the health department when they see public-health threats. But that doesn't always happen, or it often happens belatedly. And in the case of bioterrorist attacks, quick response is critical.

Researchers at the University of Pittsburgh developed a computer-surveillance method for about 25 hospitals that represent more than half of the emergency-room visits in Allegheny County and a third of such visits in a 13-county area of western Pennsylvania.

The National Library of Medicine, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention, have together provided $700,000 in direct and indirect funding to develop the system. It monitors new cases, looking for unusual increases in flu-like symptoms, respiratory illnesses, diarrhea, skin rashes, paralysis, encephalitis and hemorrhage. A graph showing the incidence of each symptom is updated constantly and can be displayed on a computer screen. The trend line should be roughly steady. If not, an alert is automatically sent. Another click of a button can show a map with the number of incidences reported within each patient's zip code.

The system identifies patients early in the disease process and then uses "brute-force computer power to find any interesting patterns among the sick individuals that would suggest that an unusual outbreak is occurring," said Dr. Michael Wagner, who developed the program, in testimony before Congress in November. By sorting patients with certain symptoms by zip code, the system can quickly pinpoint where an attack may have occurred. It doesn't require hospitals to make a special report; rather, it mines hospital computer records for relevant cases.

Speed is critical. "For an hour lost, the number of deaths can be in the hundreds or thousands. This tight coupling between detection and response is vital to stemming the numbers of illnesses and death that can occur using slower methods of detection," according to Dr. Wagner.

The University of Pittsburgh isn't the only place such technology is being developed. New Mexico has a touch-screen system installed at seven hospitals, in which staff members can enter incidences of flu-like illnesses, hepatitis and respiratory distress. The goal is to identify and link clusters of outbreaks. Boston, under a five-year $1 million grant from the CDC, has developed an electronic system for monitoring all emergency-room and acute-care facilities and reporting real-time data to the health department. On a national level, the CDC itself has been implementing an electronic disease-surveillance system, linking the country's testing laboratories with the agency.

For such technology to be useful, hospitals need computerized records. "A lot of hospitals really aren't ready to have their data mined; they're still using paper records," said Dr. Tara O'Toole, director of the Johns Hopkins Center for Civilian Biodefense Strategies. "And the ones least ready are the ones you most want -- the big hospitals in urban areas."

Success depends on quick action after notification of an outbreak. Moreover, privacy is expected to be a huge concern if systems are allowed to transmit patient information widely. The system that Pittsburgh is developing gathers only limited data such as age, gender and zip code, but not patients' names and birth dates.