In a remarkable feat of a posteriori “early warning,” Google.org has just released ‘Experimental Flu Trends in Mexico‘. Their visualization shows a spike in “aggregate search queries likely to be associated with influenza-like illness (ILI)” around April 20th. As the NYTimes notes, this is after the Mexican government was well aware of an outbreak. Unlike the Flu Trends system in the U.S., Flu Trends-Mexico has not been “verified” by matching trends from a previous years with flu isolate data. Of course, we have yet to see any impact on U.S. Flu Trends, even as cases increase and media attention heightens. To date, the role of biosurveillance systems in epidemic event detection has been minimal–a point I will raise in greater detail on our forthcoming influenza page.
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What do you make of the Veratect story? They are claiming to have detected the outbreak in early April, and to have made the information available to CDC well before there was a general alert. And they are implying that they broke the news to global health officials:
“We do know, after checking our web site logs, that the Pan American Health Organization, the WHO Regional Office of the Americas, accessed this specific report in our system on April 10th and again on April 11th.”
Its hard for me to call. On the one hand, Vertatect seems to have been following events in Mexico quite early on, and they have not been afraid to self-promote this fact. The result, for us, is a lot more public information about the early outbreaks leading up to the announcement of the epidemic than is being made available elsewhere. But a close examination of Vertatect’s timeline of events (http://biosurveillance.typepad.com/biosurveillance/2009/04/index.html) leads me back to my typical refrain: the provision of information alone may not lead to recognition (understood as ‘significant’ knowledge). On April 6th, Vertatect reported on its web portal about reports of an outbreak in La Gloria, Veracruz and, apparently, this information was accessed by the Pan American Health Organization. But we would have to see this in the context of all the other information being provided, by Vertatect and other sources, to be able to demonstrate Vertatect ‘recognized’ the influenza epidemic. I think it is likely that this report was seen as one among many reports of outbreaks around the globe. On April 16th, Vertatect sent to CDC a brief message about reports of “atypical pneumonia” in Oaxaca. Here, we have a better case for the recognition of a significant event. But again, here the e-mail that they sent noted that “atypical pneumonia cases reported at hospital” in Oaxaca, but there was not the sense of scale that would appear later. Are atypical pneumonia cases in Oaxaca inherently significant to the CDC? They probably should be, but this is a question: I believe this is a relatively common diagnosis in some parts of the world. And by the 20th, it is possible CDC and WHO already knew about the outbreak.