Global mobility has increased and the world has become more connected. But it carries a greater risk for the spread of respiratory diseases, especially pneumonia, which is the most important cause of death in children under five years of age and the elderly. Real-time and accurate data on respiratory diseases are critical for public health response – especially during an outbreak.
Pneumonia is a lower respiratory tract infection. It is caused by very small organisms that cause the air sacs in the lungs to become full. This makes breathing difficult and can lead to death. Data from respiratory disease surveillance programs help public health officials identify potential clusters that could lead to widespread outbreaks and implement strategies to reduce the impact.
Information gathered in clinics and hospitals does not provide a complete picture of a disease. This information depends on the fact that people go to health care facilities, which does not always happen. Some people may not be seriously ill, or may not be able to get to the health facility. And there may not be enough laboratory capacity to perform tests.
Using disease information facilities, it is difficult to detect an outbreak or seasonal increase while it is happening – and it is difficult to estimate the total number of numbers. There may be a delay and underreporting, making the response to public health less effective. The sooner a group of cases is detected, the better it can be managed.
There are other ways nowadays to gather information about diseases using technology. They fall under the description of digital participatory surveillance. These are platforms that allow people to regularly report their own symptoms via the internet, on a mobile application or via social media recordings. They may also raise questions about health action. Health authorities can then analyze the digitally collected data, get a bigger picture of how common a disease is in a population, and see trends that can better prepare and manage the health system.
The National Institute for Communicable Diseases in South Africa is planning a pilot phase of a digital platform for participatory surveillance. The aim is to evaluate the feasibility and inform its structure, before incorporating it into the existing facility oversight programs. In particular, this pilot phase will be used to investigate respiratory diseases such as influenza and possibly COVID-19.
Influenza is a disease that is preventable by vaccines and one of the causes of pneumonia. This causes an estimated 11,000 deaths every year in South Africa. As for COVID-19, which can also cause pneumonia, the pilot phase could potentially help detect a large increase in cases early on.
The success of a digital participatory surveillance program depends on the constant participation of the population.
South Africa already has another technological tool designed to combat the pandemic: the COVID-19 Alert app. But it is intended for contact tracing, by helping the user determine if they were near the confirmed COVID-19 case. It is different from digital participatory surveillance programs intended for long-term monitoring of respiratory diseases outside COVID-19, and does not serve for contact detection.
Digital surveillance
Digital participatory surveillance is relatively inexpensive and easily scalable for any public health disease. Users report weekly whether or not they have experienced symptoms related to respiratory system. It allows for real-time assessment of cases without relying on access to medical care or testing ability. This data can also be used to forecast how outbreaks can spread in a community.
Despite its potential value, digital participatory surveillance has not been widely used to date. But it is used in other parts of the world.
The first platform of this kind was launched in Europe during the flu season 2003/2004 and is now used in several countries, where they were able to influenza outbreaks detected earlier. The USA, Australia and Mexico has their own digital participatory surveillance programs. Today, 11 European countries set up a continent-based digital network for participatory surveillance InfluenzaNet. This enables a comparison of trends within and between countries in Europe.
Countries in Europe, and the US and Australia have increased and sustained participation on these platforms through media campaigns and public health messages. The National Institute of Communicable Diseases uses similar strategies through PR and media in South Africa.
However, South Africa’s digital surveillance of digital participation will face important challenges.
In the first place, information and communication technology restrict. Some parts of the country may not have internet connection.
Secondly, the Digital dividing line within a population means that segments of the demographic may not be fully represented because not everyone has access to smartphones or internet connection.
There may be concern and skepticism social media and mobile applications related to data confidentiality and privacy. These are years of challenges that the government and various industries have to deal with.
Move forward
As the digital world evolves, there is the opportunity to use technology to solve critical problems in public health.
Digital participatory surveillance enables the community to participate in the responsibility of disease surveillance and contribute to the control and prevention of outbreaks of respiratory diseases.
Cheryl Cohen, co-head of the Center for Respiratory Diseases and Meningitis, National Institute of Communicable Diseases and Sibongile Walaza, Medical Epidemiologist at the National Institute of Communicable Diseases and Lecturer at the School of Public Health, University of the Witwatersrand