Gates Package — page 939

Some countries are developing smart ways to get even more eyes watching for signs of danger, whether they're coming from a known disease or a new one. Most of the major outbreaks in recent years also showed up in blog posts and social media. This data can be subjective, and there's a lot of noise surrounding the signal, particularly online, but it's often a useful supplement to the insights that health officials get from more traditional indicators. In Japan, postal workers perform some health services and disease surveillance. In Vietnam, teachers are trained to file a report with local health authorities if they ever notice that several children are absent from school with similar symptoms in the same week, and 2 pharmacists are instructed to raise the alarm when they see a spike in sales of medicines for fever, cough, or diarrhea. The idea is to ensure that surveillance reaches as many communities as possible. Another relatively new approach is to go looking for signals in the environment. Many pathogens, including poliovirus and coronaviruses, show up in human feces in such a huge quantity that you can detect even a few people who are shedding the virus if you take a sample from the sewage system. Workers take samples of wastewater from treatment plants or open sewers and take them to a lab where they're checked for these viruses.. If the sewage samples come back positive, someone will visit the community they came from to identify people who might be infected, step up vaccination efforts, and educate everyone on what to watch for. The idea of checking wastewater was first developed for polio surveillance, but in some countries the technique is also employed to study the use of illicit drugs and the spread of COVID. Studies have shown it can even act as an early warning system, letting officials prepare for a surge in cases before they show up in positive test results. ***