Hi everyone. Welcome. I'm here today with guests, Dr. Lucy Wilson and Megan Wallace. Lucy Wilson is the chief of the Center for surveillance infectious prevention and outbreak response, the Maryland Department of Health. And Megan Wallace was formerly with the Arkansas Department of Health in their epidemiology division. Can you tell us a little bit about what public health surveillance is. So I think, you know, one of the easiest things to think about what public health surveillance is, is the old proverb or tome that, "What gets measured gets managed or what gets measured gets done". And so public health surveillance is really a way to measure the health of the population overall. And, once you have that information, you can really act on it to make sure that your population is as healthy as it can be. So when you say act on it, what does that mean? Like, in Maryland, how do you, how do you act on that kind of information. So I work in infectious diseases. So we identify important infectious diseases for which, we think, we can offer assistance and intervention to improve the health of Marylanders. So we would monitor a disease over time and collect information, look at our data, and then make plans for interventions in order to reduce the disease and to make the population more healthy. We've all, probably, hopefully nobody has it right now, but the flu, you know, you get the flu. So what happens if -- how do you guys get that information? So the flu is really interesting because one of the reasons we have gaps in information is not everyone who gets the flu goes to the doctor. And so people who get the flu and just stay home, I mean, we never really know about those people. So that's one of the things that gets really under-reported. Like Megan said, not everybody has symptoms who has influenza. Not everyone goes to the doctor. Not everyone who goes to the doctor gets a flu test and gets diagnosed. And, so, in order to estimate how much flu is out there and to give warnings about who should get vaccinated, when vaccination should start, when flu is peaking, when flu is ending, we have to make estimates. And so those estimates are surveys of doctor's offices as to people coming in with flu-like symptoms, surveys of emergency departments, people presenting with flu symptoms. We do full surveys in Maryland of hospitalizations for flu. We also have a survey that goes out to people who don't go to the doctor and we use that to try to estimate. The laboratories do monitoring for flu to look for novel or new flus that might cause a pandemic. Fortunately, not this year hopefully. And so there's a bunch of different ways to estimate flu. Why don't you just go on Twitter and take a poll. You know, what would the -- what are some of those challenges? Oh man! I mean one thing is just the word flu. When I talk about flu I'm talking about influenza. When the general public talks about flu, they might be talking about flu with a fever, and a cough, and a sore throat. But they might also be talking about throwing up, and vomiting, and diarrhea. So, there's different connotations to the word flu. So, if somebody puts I have the flu, we don't really know whether they have influenza. So that's one way. So it's just a rough, a rough estimate of somebody's symptoms. So it seems, like, there's always, like, every other week there's a foodborne outbreak on the TV. You know, peanut butter factory, salad, you know, something. I mean, so it seems like there's more than we used to have. Is that -- do you think that's the case? Or we just know about it more? I think we've gotten better at picking up these infections. We have a way of looking at individual people's infections with molecular techniques in the lab. And, so, if there's an outbreak from a food that is spread out across the U.S., we can now communicate with other states and find the source. An example of that would be when there was a large national outbreak with peanut butter. There was also a large national outbreak with infected cookie dough. And there was another one with infected cantaloupes. So those were all helped by combining general public health monitoring with laboratory tests. So, very exciting, that we have this new way to to find diseases and and get them out of the general population. It is amazing you hear this like all alert, you know, and you can go right into your refrigerator and look at the numbers on your peanut butter, your salad, and know to throw it away. It is pretty amazing. I guess that really is surveillance in action. Absolutely. One of the ways technology is really helping is, is getting reports in faster. I think for a long time, there is a big lag between when people were actually getting sick and when the Health Department would find out about that. And, as technology progresses, that timetable is getting shorter and shorter which is really nice because the sooner the health department knows that there's something going on, the sooner they can take steps to to try and end the outbreak or take care of whatever is happening. And so, I think, that's a really important way where technology is helping us out a lot. But what about, sort of, long term things like Alzheimer's, cancer, diabetes? And there are things that probably everybody in their family -- has family members that are struggling with, how do surveillance help with those kinds of things? So these things are very important too and, as we know, the chronic diseases in the U.S. are getting more and more important and more and more prevalent. And so we have, we're doing surveillance on things like cancer. There is a survey that goes out every year that really looks to monitor some of these chronic diseases. It really looks for you know cardiovascular issues, diabetes issues, and things like that because those are important to monitor overall as well. Yes. So, state health departments monitor all sorts of chronic diseases. They monitor cardiovascular health. They monitor cancer. There's a cancer registry. They monitor infant deaths and, really, most states have that as a top priority to target and reduce infant deaths. There are, there is population health monitoring which is all sorts of diseases and hospitalizations. And, so, there's really a huge range of what public health does monitor and what's called Public Health. Okay, we have these numbers. And we see, okay, numbers of cancers going up but then, what are the, what do you do with that information. So occasionally we'll investigate cancer clusters to see if there may be a link to a reason why a group of people in a single area are getting, if they're getting elevated rates of cancer. So that's one of the things that we can do if it looks like, you know, things like cancer rates are going up. But, you know, things like obesity rates we, like, look and see, is there -- are there -- things that we can do to make our health population healthier overall. And public health can reach out to -- to the health care and say, "Doctors, please monitor your patients for this kind of cancer." Or public health can look at health disparities and say there's this particular group of people that is being overlooked. Let's focus on cancer prevention and this group of people. And public health can reach out to the public and say, "Please get your cancer screening test." And, so, there's a lot of communication that can occur based on what's being monitored. Well that's a good point. You're talking about disparities in terms of looking at the data not just even in totality but at different population subgroups. And, I'm guessing, is that an important piece of what you all do in your jobs? Definitely. It sounds like, from what you're saying, that the surveillance piece really is the critical building block for public health that everything, actions, and research, and questions really come from. You have to have a baseline to know where you're going and to plan for the future. Absolutely. I mean, I think, it goes back to you know "what gets measured gets done". I mean, you can't really improve upon something that you don't know is happening. And, I mean, a lot of times you'll even see as soon as an infection starts getting reported, it goes down because people realize that there is an issue that they didn't realize before. And so just even the act of reporting can spur action which I think is really astounding. To the power of information. The power of information.
