Yesterday I got an email from the Department of Health here in New York City announcing that they are spraying local bodies of water in Brooklyn starting this Thursday, to eliminate mosquitoes carrying West Nile virus.
Man, it’s bad enough that we’re dealing with the Delta variant of COVID-19 — now we’ve got to remember to think about West Nile virus? What’s next, leprosy?
As we head into the fall season, we all see influenza and other respiratory viruses looming on the horizon, and we know we’re going to be in for a rough time. Indecisiveness on the part of politicians (and the general public) seems to be preventing us from getting everyone vaccinated, and already we have the push for a booster vaccine when we haven’t even gotten through enough of the community to get us to herd immunity.
Boosters definitely have their place, and none of us ever thought this was going to be a one-time vaccination. Most figured it was going to be an annual thing, just like getting the flu shot. But we’ve just been through a year and a half of hell, and gotten through a spring and summer that have been heavy with tickborne illnesses, and to be honest, I don’t think we have enough bandwidth to keep processing all this stuff. At this point, I wonder if we’re going to get to a place where, when someone comes into your office or your emergency department with just about any symptom, we’re going to have to swab them and test them for everything.
We used to have a respiratory viral pathogen panel that we sent off in the pre-COVID-19 days for those rare situations where knowing specifically what a patient had in terms of respiratory viruses was critically important to their acute management. This was often useful for recognizing syndromic circumstances prevalent in the community, as well as cohorting inpatients over in the hospital. Every once in a while, it also had utility in the outpatient world, where knowing definitively whether a patient had influenza or not made a difference. But more often than not, we ended up spending hundreds and hundreds of dollars to find out that someone had rhinovirus or adenovirus, i.e., the common cold. Let me tell you, no one was happy when they got the bill for that.
Given the onslaught of data, new diseases, new presentations of old diseases, and things we haven’t even thought of yet, we’ve got to come up with a better way of synthesizing the data, analyzing trends, and spotting new things coming at us. It’s never been enough for us to keep up with the literature in our medical journals, or even alerts from outside health agencies.
I know the tech world has been working like crazy to try to figure out how to do this, how to crunch through all the data and help us, and how to serve as a partner at our sides nudging us towards the right diagnoses. I remember several years ago when Google Flu came on the scene, and everyone was impressed how the chatter on social media knew that the flu was present in the community earlier and faster than the CDC’s influenza surveillance system. But unfortunately, I think the noise that’s generated by social media these days and the disparate opinions you find there make it a challenge to use as a diagnostic tool.
We can only hope that someone out there is thinking of a smarter system to use the power of computers, data analysis, and artificial intelligence to really get a handle on all this stuff. It’s up to us to build a system that is flexible and responsive, that’s ready for the next thing that comes at us, the next infection that we don’t even know about yet.
We need to ensure that we have a fully functioning public health infrastructure and nimbly responsive medical systems that can handle whatever Mother Nature decides to throw at us. And then we need some really smart people helping us design some really smart things that do what we need them to do, help us see the forest for the trees, and the tree in the forest, and the squirrel sitting on the branch of the tree, and the acorn in the squirrel’s mouth.
Only then will we be able to be in a place where we can really handle just about anything, and not once again find ourselves playing catch-up with yet another catastrophic threat to our communities.
Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what’s going on in the world of primary care medicine from the perspective of his own practice.
Last Updated August 25, 2021