Coronavirus Frontlines is a special series where we are sharing the perspective of experts at the forefront of combating the COVID-19 pandemic.
During every outbreak the public inevitably asks the same questions: What is my risk of infection? Am I already infected? Is the virus circulating in my neighborhood, city or state? The COVID-19 outbreak is no different. And because early testing did not happen, these questions are much harder to answer in the United States.
In lieu of testing, many of these key questions can be answered through ‘participatory surveillance.’ That might sound a little ominous, however, it’s anything but. This is a growing movement in which global citizens report their own health observations. The future of public health will require the public to directly engage in early detection and rapid response.
I know this is possible because nearly a half-million volunteers in the United States have been helping do this every flu season on a mobile app called Flu Near You. My team at Ending Pandemics created this self-reporting tool in 2012, in partnership with the HealthMap team at Boston Children’s Hospital. Since then, this simple web-based tool has been tracking population-based data on influenza activity in the United States. The tool surveys users’ health status every week, providing an instant snapshot of “influenza-like-illness” across the United States.
What’s more, Flu Near You provides users with useful information on where to get a vaccine in their neighborhood and links to relevant news articles and local resources. With the inclusion of a query on vaccination status, Flu Near You offers an additional measure of vaccine efficacy.
Flu Near You has been providing a reliable signal of flu activity in the United States that complements other flu surveillance by the government, academia and the private sector. Perhaps its greatest value is the real-time map it generates as people submit their reports. This “heat map” identifies pockets of illness among reports from those that are healthy. Flu Near You provides unique data for public health officials, researchers and modelers who use this population-based data to understand more about this yearly threat. The data is made freely available in an anonymized, aggregated manner to protect the privacy of the users.
A stellar example of how simple technology is revolutionizing the speed of detection of health emergencies is the 115 Cambodian National Hotline. The hotline has been operating for several years now and receives an average of 500 calls per day from the public. Of these, 20-30 reports require some sort of public health response. When Cambodia detected its first case of COVID-19 in late January, the hotline was used as the primary channel for reporting. By mid-March, it was receiving 15,000 calls a day. The 115 Hotline continues to play an important role for reporting suspected cases and providing COVID-19 information to the public in Cambodia. The hotline now employs 25 operators to answer calls 24/7. Ninety percent of suspected COVID-19 cases were first reported through the 115 hotline.
Participatory surveillance (based on the Flu Near You model) was implemented by Brazil during the 2014 FIFA World Cup and the 2016 Olympic Games. Today, Brazil is using this same tool for COVID-19 surveillance. Thailand, Tanzania, Sri Lanka, Cambodia, Europe and Australia are all expanding this approach by creating their own disease surveillance tools in partnership with Ending Pandemics.
This brings us back to how we can answer the questions that face us during every outbreak. When this pandemic began to unfold, it was common to see dismissive analysis that compared COVID-19 to the yearly flu. While the current healthcare emergency proves that these are two very different viruses, how we track them could be one and the same.
Flu Near You participants are helping us answer key questions through regular reporting. A few new questions have been added to the weekly survey specific to COVID-19 diagnostic tests and severity of illness. COVID Near You has also launched to bring as many new volunteers as possible into self-reporting during this pandemic crisis. The data from both systems are merged, so whether you report to Flu Near You or COVID Near You, you are helping answer critical questions for the COVID-19 pandemic, seasonal influenza, and the next novel virus that emerges on the planet.
Through wide scale, participatory surveillance, we can each do our small part to have a large impact. Together, we can prevent a threat anywhere from becoming a threat everywhere.