Cloudy, Chance of Cough

Cloudy, Chance of Cough With a new mapping tool, Ontario is the only place where people can track disease epidemics in real time—telling them when to skip daycare, perhaps, or take other steps to stay disease free. If a weather map can prevent you from getting rained on in a storm, can a map of infectious diseases in your neighborhood prevent you from getting sick in an epidemic? Scientists in Kingston, Ontario, think so. Thanks to a software system called Infection Watch Live, the southeastern corner of Ontario is the only place in the world where illnesses like flu and stomach bugs are made publicly available on real-time maps online. Maps are nothing new when it comes to disease. Italian princes used them to quarantine plague sites as early as the 1600s. Today, school boards, employers, public health officials, and concerned individuals are checking the online maps daily to see which illnesses are striking nearby, giving them the chance to plan accordingly. “There’s nothing else that will show a neighborhood what is actively going on around it,” says Kieran Moore, who is director of the Queen’s University Public Health Informatics Team and helped create the software. For a parent, the information might mean skipping daycare in a hot zone. For an employer or school principal, it might mean planning for absences. But for a hospital or public health official, it could even mean slowing the spread of the next epidemic. In 2003, Toronto garnered the grisly appellation of “SARS City.” The SARS epidemic, which had begun in Hong Kong, hit the city harder than anywhere else in the western hemisphere. Subway cars looked like operating theaters, with people wearing masks to and from work. Hospitals began to buckle under the onslaught of patients. In the midst of it all, Niall Wallace, then a data-management consultant for the Ontario Ministry of Health, rushed his wife to the hospital with an acute case of appendicitis. The emergency room was overwhelmed by SARS. “It was chaos inside,” he recalls. “People were hacking and wheezing right next to people who had come in with sprained ankles and broken bones.” The scene gave Wallace a first-hand view of what he was monitoring from behind the walls of the Ministry of Health. As a data-warehousing specialist, Wallace was working for public health officials who were trying to get a handle on the epidemic. First attempts were rudimentary: they tracked the spread on whiteboards using hospital announcements and media reports. When the numbers got too large, they graduated to spreadsheets. What Wallace saw in the emergency room convinced him that in order for Toronto to withstand another epidemic, the system would have to change. Wallace began organizing his epidemic data using a geographic information system (GIS), powerful software that links data streams to detailed geographical maps, which are easier to understand and disseminate than spreadsheets. “The map is the perfect medium for this type of work. It locates the cases, and in its presentation makes obvious the clustering or dispersal that signal a concentrated event,” says Tom Koch, author of Cartographies of Disease. But in order for the maps to be truly useful, they had to display data in real time, without a significant lag. A year after Wallace’s emergency room experience, he and Moore developed a public–private venture that combined Moore’s medical expertise and access to public health-care information with Wallace’s skills in mapping technology. Infection Watch Live pools data directly from emergency rooms across the region. When patients are triaged, basic information—whether they have respiratory or gastrointestinal symptoms, for instance—is collected with demographic information like age and gender. The software takes people’s location by postal codes; in Ontario, a code can have a half-block radius. The computer system then streams the data from multiple hospitals into a digital mapping platform and uploads a new map every morning at 5 A.M. It colors neighborhoods green, yellow, or red depending on how they compare to regular seasonal rates of illness. Wallace and Moore adapted the program from existing software designed by The University of Pittsburgh called Realtime Outbreak of Disease Surveillance (RODS), which was developed to identify bioterror events. The two revamped the software to flag symptoms like cough, fever, and diarrhea rather than the symptoms of anthrax. The system began as a pilot program in nine hospitals for a population of 515,000. It’s now in 10. Every morning, the Public Health Unit responsible for Kingston, Frontenac, Lennox, and Addington, as well as two other jurisdictions, posts the map online for the public at kflainfectionwatch.com. The resolution is such that patients’ privacy is not violated, but the community can get a sense of the movement of disease. Epidemiologists and public health officials can access the maps at greater resolution. “That was largely inconceivable even 10 years ago,” says Koch. “The collection of data from various hospitals and its aggregation across a regional map provides potentials for rapid identification of disease outbreaks—and therefore a rapid response.” In April, when the H1N1 flu strain erupted out of Mexico, Moore and Wallace had already networked most of the hospitals in the southeast corner of Ontario. “We had the only system in the world that was available and reporting to the public on H1N1,” says Wallace. In a community of only 190,000, the map Web page received some 3,000 hits daily. The site also linked to information on flu symptoms and prevention tips. “I knew numerous pregnant women who took extra precautions based on the information provided by this mapping tool,” says Moore. “In our region, we had no deaths in pregnant women. In fact, only a few pregnant women even got admitted to the hospitals. We had very low admission rates as compared to the rest of the province.” Wallace’s company, Infonaut, now sells Infection Watch Live along with two other mapping programs that track disease at different levels of resolution, ranging between inside hospitals to entire regions. In the future, he believes Infection Watch Live will become the standard in disease monitoring in Canada. “Based on the success we’ve had in Kingston, I foresee Infection Watch Live being adopted by other public health units throughout Ontario,” he says.

Cloudy, Chance of Cough

Cloudy, Chance of Cough

With a new mapping tool, Ontario is the only place where people can track disease epidemics in real time—telling them when to skip daycare, perhaps, or take other steps to stay disease free.

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Daniel Grushkin

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December 2010

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