Random thoughts on CDC's swine flu effort: epidemiology and surveillance

[indigo girl]

With all of the possible changes coming down the pike regarding health care, disease surveillance must be included for the future health of the nation. This topic begs closer examination, and planning. We have been incredibly lucky thus far that our current pandemic has not been more severe. But what if it was? What kind of shape would our healthcare system be in then?

The Reveres have made some fine points in this commentary. 2009 will not be our last pandemic. Influenza will always be with us. Many lessons will be learned from what happened this time. Hopefully, we will be more ready, and the system will function better, but I doubt it.

As for epidemiology, it was an "all hands" effort, but one wonders if the system could have sustained a much more severe event. If there had been a lot of absenteeism and a much bigger demand a lot of work that would have been desperately needed probably would not have gotten done. As it is a lot of non influenza work didn't get done. One reason for the heavy load on CDC was that the states were not in good shape. State and local public health is where the rubber meets the road in US public health and the road definitely was full of potholes, detours and closures. CDC has a lot of expertise but a thin reserve and there is no way it can be the nation's health department. So I'll give them a B, realizing that there wasn't much they could do to raise their grade. Too much homework and not enough time to study.

The influenza surveillance system was augmented and provided critically important information. But it is a jury rigged system, a mosaic of different sources of information and heavily dependent on state and local health departments (see above). It really needs an overhaul and if Obama's Electronic Medical Record (EMR) initiative goes forward CDC needs to be at the table. Maybe they are, but somehow I suspect if they are, they aren't a major player. The EMR is being touted as a major cost saver and rationalizer of medical care, although I am extremely skeptical about those claims. On the other hand it could be an extremely important way to get timely medical information for surveillance purposes, but only if CDC makes sure it is designed to include this need. It's not just a matter of harvesting information collected for other purposes. The system has to be constructed in such a way that it can be used by CDC. This would include making sure it generates useful information for surveillance and allows it to be gathered in a form that doesn't compromise patient confidentiality or run afoul of HIPPA or other reasonable privacy concerns. It would be a shame if the information was there but couldn't be accessed.

...while the surveillance system sort of worked during this not catastrophic pandemic, I have the feeling that as with the heroic epidemiological effort, we dodged a bullet.

Full commentary at: http://scienceblogs.com/effectmeasure/2010/02/random_thoughts_on_cdcs_swine.php

The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.