Saturday, February 18, 2012

Infectious Disease, Human Security, and Social Media

The concept of human security is based, in part, on a widening of our understanding of what constitutes a security threat beyond the traditional focus on military threats in the concept of national security.  Human security includes concern for military threats, but it also encompasses threats related to food shortages, pollution, poverty, and disease.  Health insecurity, in fact, is one of the most persistent and problematic of all forms of insecurity if we judge such things in terms of lethality and impact on quality of life.  Consider that the wars of the twentieth century were responsible for roughly 100 million deaths while smallpox (now eradicated) killed somewhere between 300 and 500 million people during the same period.

One of the keys to gaining the upper hand in the war with microbes is understanding--and responding rapidly--to the spread of infectious diseases.  For humans to continue with business as usual when communicable diseases are running rampant among the population is to give a tremendous assist to the bugs.  Especially now, when, for the first time in human history, over half the world's population lives in urban areas, failing to get a flu shot, to cough into a sleeve, to stay home when running a fever, or to avoid crowded spaces can jeopardize the health--and sometimes the lives--of others.  The problem, however, is that sometimes infectious diseases are spread before their human carriers even know they are sick.  By the time the coughing, sneezing, vomiting, or other unpleasantness arrives, the viruses causing the symptoms may have already been spread.  Infectious diseases are often stealthy.

The solution, as public health experts have known for a long time, is to ensure that healthy people take precautions against the spread of disease as soon as those less fortunate begin to manifest symptoms.  The key to my continued health, in other words, is to take note of your illness and to avoid you (like the plague, as it were).  But if I take note of your illness only after you've shaken my hand or sneezed in my general vicinity, it's too late.  I may already have what you have.  The key, therefore, is public monitoring and reporting of the fact that an infectious disease is making its way through the local population.

Public health authorities in every state of the United States and in most of the world's countries collect information regarding the spread of infectious disease.  In fact, laws mandate that hospitals and clinics report on the incidence of various diseases that have been diagnosed and treated.  Massachusetts, in 1874, was the first state in the United States to initiate the systematic reporting of illness by physicians.  Michigan, in 1883, was the first to require such reports.  Today, the Centers for Disease Control and Prevention (CDC) collects aggregate data on disease and mortality from the states.  The World Health Organization (WHO) performs a similar function on the global level.

Reporting of this type is essential for epidemiologists.  It can help health care providers to know what is happening when people start appearing for treatment with symptoms that could be explained by a variety of different conditions.  It can allow pharmaceutical companies to know when to ramp up production of particular vaccines and where to ship those that they have produced.  But it may not be timely enough to let me know that I shouldn't ride the subway into work tomorrow because a bunch of people in my city starting coughing and sneezing in just the last 24 hours and some of them are likely to tough it out and go to work tomorrow in spite of the fact that they're spewing pestilence.

This is where social media may help.  A new website call Sickweather (with changing mottoes that include "cough into your elbow," "we be illin'," and "don't touch me") is attempting to map the spread of various illnesses in real time by collecting the clues we post on Facebook, Twitter, and other social media regarding our state of health.  So when people Tweet about being up with a sick kid all night or update their Facebook status with something like "my head is so full of mucus it could explode," Sickweather takes that information and (presumably after a "whoa, dude, TMI") includes it in the database of illness reports.  By mapping the location of those who post their health reports (when location can be determined), Sickweather is able to generate a sickweather map.  Sickweather also invites visitors to the site to log in and fill out a quick health report.  (Calling all hypochondriacs!)

There are some, ahem, bugs to be worked out, no doubt, but the concept seems to be full of potential.  John Metcalfe of The Atlantic reports on Sickweather here if you need a bit more information.

There's much to be learned about human behavior, and threats to human security, by mining our online data.  In fact, I suspect one could track (and issue warnings about) outbreaks of karaoke, wine snobbery, and Angry Birds expertise in much the same way that Sickweather is handling illness.

"Red nose at morning, sailors take warning."  Seriously, you should check out Sickweather just for its ever-changing tag lines.