Early Detection of Health Crises

Earlier this year, in a DICE webinar with Dr. James Wilson, he said that global health crises historically emerged every 5 years, but since 2000, we have seen this cadence become ever more frequent through the onset of SARS, Swine Flu, MERS, Ebola, Zika and of course COVID-19.  And now, with the Monkeypox arriving even more ahead of schedule, and alarms being sounded due to the discovery of the Polio virus in NYC and UK wastewater, this leaves the PathCheck Foundation and many scientists wondering: Are health crises coming around even faster, like veritable disease hurricanes driven by climate change, or is early detection and signal validation just getting better?

To answer that, let’s look at how COVID-19, Monkeypox and now Polio are entering the news cycle.

COVID-19 blindsided everyone, and while it took some time to ravage the US from its onset in Wuhan, there was very little warning, which was compounded by the suppression of information coming out of China. By the time news of a new virus made headlines around the world, it was hitting our shores and already too late.  The viral life cycle was well underway.  Early detection in that case was non-existent despite the tremendous effort to sequence and develop testing capabilities in record-breaking time.  It was a worst case scenario of a new, emerging infectious disease that had no baseline for testing or surveillance, and for all intents and purposes was more of a 100 year health crisis than a 5 year health crisis.

With Monkeypox, we have the testing, vaccines, treatments and knowledge of the virus from well before this current outbreak started, so why is it taking us by surprise?  There is a taboo surrounding this current outbreak that has prevented some from seeking treatment, and we know from Ebola outbreaks that this taboo nature can be challenging for public health response when people are afraid of seeking help. And then there are the supply chain issues, like losing our stockpile of Monkeypox vaccines in the U.S., that have helped this virus gain unfettered access to various populations.  All of this means that by the time you hear about case counts in the media, you can assume the number is already much larger.  Not only because many of those cases are hidden from the data, but because the lag in testing creates inherent delays in reporting to the media, which can then sometimes represent the case counts from several weeks ago. This puts public health agencies in a reactionary position rather than a proactive one.

In the examples above we have both an emerging infectious disease (aka Disease X) taking the world by surprise, and then a well-known (and ostensibly easier to track) disease emerging in surprising new ways, but with Polio we are seeing a very different pattern. The news of the recent wastewater detection of Polio was circulated before any confirmed cases were actually known, giving both public health agencies and the media advance notice before the cases started to emerge, which they now have.  Why this is happening has some physicians and scientists speculating that perhaps polio has been circulating under other misdiagnoses, and/or that the oral, attenuated poliovirus vaccines may be reactivating, so to speak, within the stomachs of children to then reemerge in their waste, like some viral Phoenix rising from its ashes.  Regardless of the origins, wastewater detection is proving to be a powerful tool for early detection when those data are made actionable and available.  But what are some other methods of early detection that can be leveraged for various infectious diseases?  Here is a brief list of early detection methods currently in use that can all aid in response time, exposure notifications, and understanding the baseline of health for a population:

Wastewater detection: Studying wastewater became more well-known during the COVID-19 pandemic. This process helps scientists detect any viruses that shed in the gastrointestinal system, and therefore identify potential outbreaks without ever seeing a patient. Public health officials can be put on notice earlier, collect the resources necessary to confirm and respond, and protect communities at a greater scale. This is a fantastic tool for early warning signals and should be used alongside other data.

Social listening: My former company Sickweather was a major utilizer and innovator of this method, which has been proven through several other studies to provide accurate early warning for influenza and other conditions by analyzing public posts on social media channels. Social listening can provide additional insights into the earliest symptoms of any disease or environmental trigger before testing may even be available and without requiring participation from a population (since enough people already overshare on social media). It also helps understand what may be circulating among populations that don’t necessarily seek or trust medical interventions and who therefore are hidden from traditional surveillance.

Surveying / Crowdsourcing: One of the best methods of early detection is to survey a population about their symptoms.  FluNearYou was an early example of this for tracking influenza. This method has become immensely popular in the wake of COVID-19, originally as a means of re-opening for schools, offices and events and to address liability concerns. Creating a way to survey a large population for early detection of various conditions is the Holy Grail of early detection in the absence of wastewater detection and testing. This is why PathCheck Foundation is working to build a crowdsourcing standard and framework for early detection.

At-home testing: Having a baseline of disease surveillance can also be informed by at-home testing, and as more people become accustomed to swabbing their own nasal passages or spitting into a vial, the more likely at-home tests will be able to provide early detection. The promise of something like a Star Trek Tricorder for the home would be the ultimate manifestation of this concept. Makes me wonder if Dr. Bones ever considered the implications of early detection capabilities of the Tricorder if it had been more widely distributed throughout the Lower Decks. Of course, the future world of the Starship Enterprise likely had other solutions for fighting viruses. 

So, to wrap things up, I think it is safe to say that we are becoming better at early detection and signal validation and making significant progress with these tools, which may be contributing to the perceived increase in health crises. As the world becomes more interconnected than ever, early detection will continue to be an important (if not the most important) component when it comes to fighting infectious diseases. We may not have the futuristic tools of the Starship Enterprise, but we do have what it takes to get ahead of these diseases, so long as policies and procedures to take action are able to keep up with the technology.  That’s a topic for another blog.