How To Identify A Killer Virus -- Epidemic Outbreaks, Biological Attacks Detectable By Simple Electronic Reporting Method

Because happy endings in real life are less certain, a pilot program to help doctors identify and contain disease outbreaks has begun at the Department of Energy's Sandia National Laboratories -- a prime developer of technologies intended to mitigate the impact of biological weapons deployed by terrorists. The program is expected to become operational this summer.

The idea is to close the time gap between identifying the outbreak of a disease and learning that it is terrorist in origin. The propagation pattern should be significantly different, as would treatment patterns.

The information also should help health care providers more quickly identify and treat natural disease outbreaks.

The procedure -- which certainly, on a movie set, would build tension quickly -- will make it easy for doctors to use the Internet to transmit data to a central computer that houses information about diseases they encounter every day. A color-coded map on the central computer's screen will make it immediately apparent if a particular set of disease characteristics has appeared in a given area. If the disease expands in space over time, the area could be cordoned off. Vaccines would be immediately shipped to doctors in the area.

"No such program currently exists," says Sandia team leader Al Zelicoff, who is both a medical doctor and a physicist at the Lab's Center for National Security and Arms Control. "We've designed a system so that when a first wave of reports pops into emergency status, all the parameters needed to characterize the disease are already in hand."

Such a system would have been invaluable in the recent and possibly recurring outbreak of West Nile fever in the New York City area, he says. The disease was originally misdiagnosed as St. Louis encephalitis and weeks went by before it was clear an outbreak was occurring.

"Imagine a surgical resident who's working the emergency room of a hospital," says Zelicoff. "What does he or she know about infectious diseases or what's been circulating in the community? Basically, nothing. It'll give quite an update for them."

While reporting sniffles is important to keep track of ordinary diseases making the rounds, "We want our system to characterize and differentiate an outbreak from things that look like, say, influenza, but aren't -- like biological weapons," says Zelicoff. "In order to differentiate signal from noise, we have to know what the noise looks like."

The DOE has contracted with Sandia to provide a system with two parts, says Zelicoff. One would be of use to health care providers caring for patients with acute, apparently infectious diseases. The second will help public health authorities manage commonly occurring outbreaks and recognize an unusual disease pattern that warrants special concern or intervention.

The project is a small part of a larger, international program already funded by DOE -- the Chemical and Biological Non-Proliferation Program (CBNP), which collects data on disease internationally.

The $50,000 pilot project will be limited to diseases reported at the University of New Mexico (UNM) Hospital Emergency Room and Urgent Care Center. The information will be sent via to a central computer at the New Mexico Department of Health. If the system works well, it would be simple to expand it to include other states, says Zelicoff.

"The Centers for Disease Control in Atlanta is looking for a robust, simple, and rapid syndrome reporting system for naturally occurring diseases in the United States," says Zelicoff. "They know what we're doing, and would like a national system similar to it." The Department of Defense has asked for a briefing in Washington in May.

Six syndromes will be reportable with simple entries: flu-like illness, adult respiratory distress syndrome, bloody diarrhea and fever, watery diarrhea, rash with fever, and diffuse central nervous system dysfunction with fever.

To make things simple for the physician, demographic data like age, sex, and zip code will code automatically into the system. The intent is for all data to be enterable in a minute or less. Database information is expected to be available for the headquarters operator within moments of entry by the physician.

Sandia will provide PC workstations with touch screens, databases, client software, technical support, and funding for administrative assistance and implementation to UNM, as well as to the New Mexico Department of Health. UNM will provide clinical expertise and data entry. Los Alamos National Laboratory has provided interface software compatible with database reporting common to the medical industry.

Because the privacy of patients is an issue, Sandia is providing special encoding of medical information.