Trend SpottingEven Google can't cure the flu.
Posted Friday, Dec. 12, 2008, at 7:15 AM ET
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StumbleUponThe real question here is: So what? Why is so important to predict a couple of days ahead of time which states have lots of people with flu symptoms? Some say this information may spark health officials or doctors to produce special news bulletins, intensify hand-washing campaigns and flu vaccination efforts, let hospitals know to up their staffing levels, or even prescribe preventive antiviral meds, like Tamiflu, to high-risk people. Those sorts of prevention efforts do actually reduce the flu spread. But it is unclear what good a one-week heads-up can do when it is already clear that the flu is coming, anyway.
If Flu Trends is not the perfect surveillance system, then what is? The ideal system would let health officials know where influenza hits, how serious it is, and what the viral strain is. It would give us advanced warning to help prevent spread. Problem is, no data source has all this info—each has limitations. The flu has a predictable pattern: You get infected, you spread it to your family and friends, you start feeling awful: fever, cough, aches, headache. Then you complain to your wife or mother (whom you have already probably infected), telephone a nurse hot line, or buy some cold medicine. Ideally, you call in sick to work or avoid school, and, finally, you type "flu symptoms" into your Google browser. There is surveillance for all these activities—except for the whining, of course. Most folks ride it out at home and stay in bed for a couple of days, but some go to doctors' offices or to the E.R, and some of those doctors will order influenza tests. But by the time we have the hospital data, the flu has not just arrived, but has infected lots of people, and interventions to reduce its spread are less effective.
Probably the best answer is for officials to use multiple data sources for syndromic surveillance simultaneously and perform graded interventions with each new bit of information. When the earliest warning system goes off (like Flu Trends or drugstore purchases), health officials might announce "Flu is here" and urge people to get more rigorous with hand-washing and get vaccinated if they haven't already. Then, when the hospital data warn that the flu has landed in a particular location and is having an extreme effect on a population (like children or the elderly), targeted interventions can be implemented at the regional level, as with Tamiflu prophylaxis, or even considered for more drastic measures, such as temporarily shutting day care centers.
Another future trend in syndromic surveillance is sharing information between jurisdictions that now adhere to political boundaries such as states, counties, and cities. Diseases often spread across state lines without asking permission from health officials. So regionalization or nationalization (like Biosense) of surveillance may help us identify outbreaks that are not confined to one particular area.
But despite all this, it is important to keep a grounded perspective. The way to prevent yourself from getting the flu is to get your shot, wash your hands, and stay away from coughing people. When you do get it, stay at home, for goodness' sake. And along with your daily searches for Britney Spears and government bailouts, keep on Googling for flu remedies. By doing so, you're not just informing yourself, you're also helping the health department. But no matter how accurate Flu Trends is, we can be certain about three things this winter: 1) Flu will come; 2) many people will get sick, and some will die from the infection; and 3) Google Flu Trends will prevent neither 1) nor 2).
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