Are the systems that public health agencies have in place to receive and handle reports of suspicious diseases adequate? In an effort to answer that question, the RAND Corporation polled 19 of the 2,800 public health agencies around the United States. The study found inconsistencies in reporting methods that showed a need for national standards. The study also found that staff training needed to be enhanced.
Hospitals, labs, and clinicians are supposed to report any suspicious symptoms that could have an impact on the larger community to public health agencies. Adequate response to these reports can often mean the difference between isolated cases and an outbreak. Health agencies also use these reports to see trends in the community. In the event of a serious outbreak, the reports can help officials identify the range of exposure and the genesis of the disease.
RAND found that health departments have different reporting systems in place, says Dr. David Dausey, lead author of the report. For example, many of the agencies encountered had a 24-hour on-call epidemiologist, but the methods for contacting the expert varied from cell phones to pagers to voicemails.
None of these methods are foolproof and any of them can result in lost calls and unreported cases of disease. But it is not clear yet what method would be best, says Dausey. Standardizing the mechanisms for reporting would greatly benefit the agencies, he says.
“We need to really center in on a set of metrics and check those over time,” says Patrick Libbey, executive director of the National Association of County and City Health Officials.
Meanwhile, says Libbey, some public health agencies have made drastic improvements in recent years, including better communications with other emergency management agencies.
For example, Arlington County, Virginia, uses an electronic surveillance reporting system that groups disease conditions into categories and allows public health agency officials in multiple jurisdictions in the Washington, D.C., metropolitan region to compare reports about symptoms.
The county has a communicable disease bureau that is staffed by nurses who are specially trained in infectious diseases and biological and chemical agents. After hours, calls are directed to a 24-hour operator in the poison control center who is tasked with contacting the on-call communicable disease nurse, using either a land line, pager, or cell phone.
In Suffolk County, New York, near New York City, nurses at the health department are tasked with calling every hospital in the area daily. The nurses ask if any suspicious cases were handled or symptoms observed, which often means the health department is made aware of cases before the hospital gets a chance to report the incident.
Some public health agencies have also made strides in training staff. Training has been the focus of the Nassau County Department of Health in New York. For the last three years, the department has focused on creating emergency management plans, training their employees, and performing drills to test response measures. The department also provides incident command training to every health department employee and provides more specific training related to each employee’s job. For example, the sanitation staff has been trained in how to respond to a suspected case of biological and radiological contamination.
But Dausey says that the study found local public health agency employees needed to be better trained in when to escalate suspicious cases to health agencies at the state level. In many of the agencies studied, health department workers were reluctant to report suspicious symptoms for fear of being perceived as being alarmist, he says.
“Even when they were presented with something that should clearly be troubling to a person with clinical knowledge,” Dausey notes, “they were very hesitant to both make recommendations or do anything to take action that seemed immediately appropriate.”
While the study findings indicate a need for improvement in how local public health agencies respond to suspicious symptoms and diseases, the good news is that health agencies are aware of the problem and are working to do the best with the limited resources available to them. “Are we where we need to be?” asks Libbey. “No. But we have come a long way.”