Sharing data key to West Nile fight, Flushing doc says

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Asnis, chief of infectious disease at Flushing Hospital Medical Center, was the first health-care professional to identify a case...

By Nicole Flatow

Summer is the season for West Nile Virus, but Deborah Asnis is confident Flushing Hospital has the situation under control.

Asnis, chief of infectious disease at Flushing Hospital Medical Center, was the first health-care professional to identify a case of West Nile Virus in New York City, and she was one of several doctors and professionals to address staff at Flushing hospital about the state of infectious diseases at a symposium last Thursday morning.

West Nile Virus was the only disease discussed at the symposium, “West Nile, SARS & Beyond,” that is not associated with bioterrorism, but Asnis and co-coordinator Robert Cropi had reason to address West Nile Virus anyway.

Asnis estimated that Flushing Hospital has treated the largest number of confirmed cases.

“As a municipality, we’re far ahead of most other areas as far as educating our own medical staff,” Cropi said.

Asnis pointed to the relationship between her hospital and public health officials as the key to identifying her first case of West Nile, and to tracking diseases in general.

“Before Sept. 11, we never even bothered to call one another,” Asnis said.

But it was public officials whom Asnis contacted when she suspected a case of West Nile Virus at her hospital. She said she has since learned to use the city Health Department as a resource, because it has information unavailable to the hospital. In this case, she was also able to expedite the testing of lab results confirming her suspicion that her patient had West Nile Virus.

Often, Asnis said, the Health Department will have information that can identify and clarify patterns for the hospital.

Don Weiss of the Health Department explained to hospital workers the significance of a data collection strategy known as syndromatic surveillance. The strategy identifies trends in symptoms, which may signal the emergence of an infectious disease in a specific area.

Syndromatic surveillance tracks the frequency of certain symptoms over time, including fever flu-like symptoms, vomiting, respiratory symptoms, and diarrhea.

One of the method’s assumptions is that most bioterrorism diseases start with flu-like symptoms. Because flu-like symptoms are so common, it is difficult for doctors to identify the beginning of an incidence of bioterrorism. That’s why researcher Rebecca M. Young urges hospital workers to consider the patient’s input.

Young conducted a study examining the public’s perception of communication from health authorities during an infectious disease outbreak. Participants in forums in six cities throughout the United States reported feeling overwhelmed with information from the media but uninformed by their direct superiors at work.

Young found that concerned individuals took it upon themselves to examine their symptoms or risk of contracting an infectious disease.

“It’s worth listening to what people have to say, even when [their ideas] seem far-fetched, because often concerned patients have done more to research their own symptoms than their doctor,” Young said.

“Very often, before an astute clinician, there is an astute patient.”

Young cited a barrage of media influences and conflicts among authority as problems that contribute to poor communication with a community during a crisis.

It takes a three-way partnership between providers, public health officials and emergency management agencies, said Susan C. Waltman of the General Counsel of Greater New York Hospital Association.

As the leader of the GNYHA’s Emergency Preparedness Coordinating Counsel, Waltman examined emergency management before, during and after Sept. 11.

Besides improving communication, she listed identifying and responding to events as another important step to improving emergency management. The GNYHA now gives briefings to its staff on incident command systems, radiological events, chemical events and biological events.

“These are things we thought we would never have to give briefings on in the [United States]” Waltman said.

For the participants in Young’s study, the most blaring mistake by authorities was to neglect giving the public some sort of closure.

She said those who participated in the study were most eager to be debriefed, and to have their questions answered.

Members of hospital staff who attended the event were equally happy to be informed.

“I liked the talk about surveillance, and about the management. It kind of gives us a little bit of a guideline,” said medical student Brian Lipari.

Medical student Ed Wong agreed.

“It’s good to know that there are infrastructures set up,” he said.

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