Going Viral: The Digital Future of Public Health | Rachel McKendry | TEDxExeter - Buy Bentyl

Going Viral: The Digital Future of Public Health | Rachel McKendry | TEDxExeter

Going Viral: The Digital Future of Public Health | Rachel McKendry | TEDxExeter

By Bryan Wright 7 Comments September 8, 2019


Translator: Rachael Williams
Reviewer: Denise RQ Hello everybody. I’d like to begin by asking you
to please take out your mobile phones. I know it’s not a request that you’ll be asked
at the beginning of many talks. Normally, you’re asked to put them away, but please don’t be shy
take them out and hold them up. There’s quite a lot of rustling, but already I can see that virtually
everyone in this room has a mobile phone. Now, in the palm of your hands is essentially a small,
personal supercomputer. Yes, even the oldest models have
more number crunching power than the entire NASA mission
that first put man on the Moon. Today, I’m going to tell you
about our research which aims to harness the power
of digital technologies to build a global early warning system to prevent deadly viruses
from spreading around the world. So why is this needed? Well, infectious diseases rank among
the gravest threats to human health alongside global warming and terrorism. Tiny invisible viruses and bacteria are always changing,
always mutating, always evolving. They also have a remarkable
ability to spread from one person to another, to another. They can infect young and old,
rich and poor, black and white. In fact, all races and all nations
are susceptible. When it comes to infectious diseases,
it’s not them and us, it’s us; we’re in it together. The recent Ebola outbreak in West Africa is a stark reminder of the challenge
of containing a contagious disease in our increasingly interconnected world. It also highlights the vital role
of public health, and the urgent need
for better public health systems. While an individual doctor
will do their very best to treat the patient
there in front of them, they might be unaware of similar cases in other towns
or in other parts of the country. That’s the role of public health and their mission is
to protect populations. So we’re talking about
much larger numbers of people. And they look at patterns of disease. But the best way to prevent
a disease from spreading is to detect it early at source. And that is why these incredibly brave
men and women went to West Africa to the source of the Ebola outbreak. They risked their own lives so that we, the world,
could be protected from the risk of Ebola. But the sad reality is that many developing countries
have little public health infrastructure, so Ebola went undetected
for three months, smoldering, and when it was diagnosed,
it was primed to explode. While Ebola is terrible, an airborne virus
is a much greater threat. In 1918, a new form of influenza
spread around the world in tiny airborne droplets. It infected a third
of the world’s population, killing 50 million people. That’s more people than World War I. Over the last century, we’ve seen tremendous advances
in modern medicine and public health. They’ve brought us
antibiotic wonder drugs, advanced diagnostic technologies
shown in the lab here, and vaccines. And each of these advances has contributed to the tremendous gains
in life expectancy that we’ve seen. But today, in 2015, pandemic influenza remains at the very top
of our government’s risk register. It’s not a case of if a new strain
will emerge, but when. Because they emerge via
a natural process, they’re evolving. The human consequences
could be devastating. Estimates suggest that millions of people
could die here in the UK. But it’s the element of fear
that can snowball a humanitarian, a social, an economic,
and a global security crisis. When a pandemic emerges
normal life ceases to exist. People stop going to work. They stop going on buses and trains. They stop going to school. This means borders can close,
and essential services can fail. So the economic impact alone could put our banking crisis
into perspective. Thankfully, pandemics
occur relatively infrequently. But each and every day,
in doctor’s offices across the country, our doctors are finding it
increasingly difficult to treat bacterial infections that once were treatable
due to antimicrobial resistance. And here you can see
the drug pipeline has dried to a trickle. Sally Davies, our Chief Medical Officer,
called this a ticking time bomb and highlighted the need,
not just for better antibiotics but for better public
health systems across the world to prevent these disease epidemics
happening in the first place. In all cases,
early detection plays a crucial role, and we typically rely
on accurate diagnostic tests, because these inform
the correct intervention. Should we give someone an antibiotic
or should we isolate them? Here in the UK, we have one of the best
public health systems in the world, and they rely on looking at diagnostic
test results from those laboratories. But, even there, we can see
there are inherent delays between the exposure of a virus
and receiving a confirmed diagnosis. So let’s look more closely
at what happens. So, typically, if someone’s
exposed to an infection, there’ll be an incubation period. They’ll feel quite fine. Then symptoms will begin. It could be a sore throat,
a cough, a fever. The person will typically still try
and continue their normal life, going to visit their friends,
going to work, going to school. Each time there’s a risk that they could pass it on
to someone around them. At some point they’ll start telling people that they’re not feeling well,
and looking for information. And if they’re really unwell,
they’ll visit a doctor or a hospital, and at this point, a sample’s taken and it can be sent off
to a diagnostic lab. There are further time delays though between waiting for the results to come and sending them back
a follow-up appointment, and it’s only then
the correct interventions can be given. So we’ve got this time delay
between exposure and diagnosis, and it leads to missed opportunities to give people the right treatment
when they first turn up at their doctor. Often, the wrong treatments are given. For example,
antibiotics to treat a viral infection. But this time delay
has serious consequences on public health efforts
to prevent the spread of disease. It’s typically two weeks
between exposure and a diagnosis for flu, and in that time a strain, like a person, could have jumped on a plane
and traveled around the world. Remember, it took three months
to diagnose Ebola. So there’s an urgent need
to turn back the clock and to try to pick up infections
there and then, when people visit their doctors
or even at the onset of symptoms. And these compelling clinical needs
inspired me to bring together a truly fantastic team of researchers to build a 21st century
early warning system to prevent the spread of diseases. So we’re harnessing
the millions of symptoms that are reported on the web each day and linking these to a new generation
of mobile phone connected tests. Our aim is to strengthen
existing public health systems, so we’re linking them
to laboratory test data. But these methods could also bring a new generation
of public health infrastructure to developing countries
who don’t have them at the moment. So the team is fantastic. We’ve got chemists, physicists,
engineers, computer scientists, epidemiologists, medics,
virologists, microbiologists, from five UK universities, the NHS,
Public Health England, and industry, and we’re all passionate about building
better public health systems. We’re taking advantage
of the digital revolution. It’s here, it’s a reality. Today there are 7 billion
mobile phone subscriptions. That’s more than the number
of people on the planet. Some might argue
they’re spreading faster than viruses. But, jokes aside, we’re seeing incredibly high levels
of use in developing countries, and, in fact, they can be
the single most advanced technology in some remote villages. We’ve also seen half
of the world’s population is now online so if everyone with a phone
or a computer turned them on, it would be a digital map
of the human race. And many of us
don’t leave home without them. One of the first examples
of the use of web technology to identify outbreaks goes back to 2003 when the ProMED Internet
reporting system showed this post. It’s talking about an epidemic
in China, and here you can see, “Have you heard
of an epidemic in Guangzhou? An acquaintance of mine
from a teacher’s chat room lives there and reports that hospitals there
have been closed and people are dying.” That was the first public report of a disease that later became known
to the world as SARS. It didn’t come from a government. It didn’t come from
the World Health Organization. It came from an individual
member of the public, and it shows the power
of the individual to identify outbreaks. The official reports
came several weeks later. But mobile phones
have changed enormously since 2003. In fact, they’ve changed since 1973, when the first phone call was made
in the month that I was born. Every year the components
in our phone have got smaller, they’ve got faster, and it’s become cheaper
to send and receive information. In fact, I find it incredible that today the smallest feature on your smartphone
is smaller than a virus. And these technologies can be made
at a price that’s affordable to all of us. But this is changing the way we live. It’s changing the way we work,
and it’s changing the way we learn. This morning, many of you
will have checked your phones within 15 minutes of waking up. During the day, you’ll check it
several tens, maybe hundreds of times. Some of you might be checking it
during my TED talk. But now, phones
have overtaken fixed terminals as the main way we search for information. And indeed, 80% of us search online
for information about our health. Google have shown
that you can take those search queries, anonymize and group them,
to detect outbreaks of flu-like illnesses two weeks before
traditional public health efforts. This is their mapping system which is
available online for you all to see, and we’re working with Google now to improve the modeling
that underpins the analysis of these data and developing flu trends
for the UK for the first time. We’re also harnessing
the power of social media. Each day, millions of people
send tweets about their health. Not everyone
who tweets about flu has flu, they’re often tweeting a
bout people around them, but we’ve seen more tweets about
flu-like illnesses during flu season, and we can combine both
search data and social media data to create a real-time mapping system to now cast outbreaks across the UK
as and when they occur. We’re applying this to flu, but it’s a platform technology that can be extended
to other disease areas. And we’re beginning an ethics project
with members of the public to look at the wider issues
of data privacy and data security in order to responsibly develop
these technologies for public health. But symptoms aren’t a diagnosis,
and two diseases can share common symptoms so accurate diagnostics
remains the cornerstone of our early warning system. Our aim is to bring diagnostics
out of those laboratories and to where they’re needed, to people, so a doctor can give a test
and result in a single visit, or even ordinary people, like us,
can test in our own homes; or carers, parents, dads,
can test their loved ones and this is part of a growing trend
in the empowerment of patients. So it includes the use
of home diabetes monitoring devices and wearable technologies
such as the Apple Watch, where you can measure your own pulse rate. This is a project, a pilot study,
we’ve begun with flu survey where thousands of people
are sending us their symptoms of flu-like illnesses each week, and 700 have been sent
self-swabbing kits to their home. When they have symptoms
of flu-like illnesses, we ask them to take a cotton bud
and to take a sample from their nose, pop it in this tube,
and send it back in the post to us, and we can analyze the results in the lab
to see what viruses are circulating. And it’s a great example of the use
of the public to track outbreaks. But we can go one step further, and we’re using the censors
that are crammed into the phones to give diagnoses there and then, and to connect the results
into our early warning system. Here you can see an app
that we’re developing to read out commercial test results. These tests work in much
the same way as a pregnancy test, where you look for a line, and if the line is present, you have flu. The human eye is very sensitive, but it can be quite difficult
to read out these faint lines, so we’re letting the smartphone camera
do the hard work for us, and at the click of a button, an image can be analyzed,
stored, and sent into our early warning sensing system in real time,
with geographically linked information. But we can go one step further and make increasingly complicated tests
that look at panels of biomarkers to search for different viruses. Here you can see an example
where we’ve created a bio-barcode and in much the same way
as a supermarket scanner scans a barcode on your shopping, we can use a smartphone camera
to analyze this barcode immediately. We’re also working with industry partners and here’s an example
of an all-electronic test, where we’ve taken a tiny chip
that’s already found in your phone, called a surface acoustic wave censor, and we’ve tailored it
to diagnose a virus, in this case HIV. If a finger prick of patient’s blood
contains the virus, it will generate
an electronic signal on this chip which can be sent
to the phone via Bluetooth. Again, in all cases, we’re harnessing
the mobile computing power of phones, and the ability to send
and receive the data in real time, with geographically linked information. But an early warning sensing system
must be linked to a rapid follow-up response, so we’re working with the NHS, and international healthcare providers
to create that link, so that someone can get
a follow-up appointment immediately or can even be sent a prescription
to their phone in some cases. One of the most exciting
new developments is this collaboration with the Africa Center
for Health and Population Studies. It’s located in Durban, in South Africa. It’s one of the poorest parts
of South Africa, and it’s also the epicenter
of the HIV pandemic. But even here there are surprisingly
high levels of mobile phone usage. They’re not smartphones,
but they’re coming, and as the price continues to drop,
we think we’ll see that trend continue, and they’ll be much more widely available. In recent months,
we’ve seen an unprecedented use of mobile technologies
in the fight against Ebola. Text alerts are being used to get
up-to-the-minute information to people in Ebola affected areas. Mobile phones and tablets
are being issued to healthcare workers to connect results
from the field to central labs. Phone locations are being used
to map potential outbreaks and contact tracing to identify
those at potential risk of infection. To conclude, the world needs
better public health systems, so that next time a virus emerges
we’re better prepared. And it will come. We’re only just beginning to see
the power of digital technologies, but it’s clear they do show promise
to help patients and populations, and it’s their widespread use and low cost which could help to provide better
public health systems across the world. Wouldn’t it have been incredible if we could have detected Ebola
three months earlier, when it first emerged
in those tiny villages? At the heart of this public health system, a digital public health system,
is the public. That’s you and you and you and me. So I urge you to get better informed
about infectious diseases, share your data and connect your results, and together,
we can fight infectious diseases. Thank you. (Applause)

7 Comments found

User

Dylan Ash

1st comment

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User

Global Health with Greg Martin

Interesting talk… Looking forward to seeing more of this.

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User

daniel braswell

This is the future, but it's also a day to day reality. This was a very informative talk, I'll look for more of this conversation.

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User

Yudha Saputra

Indeed. It needs an orchestra to create a symphony. Better we work cross profesionalism to cure, health and all aspects itself.

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User

MultiRavindra007

A very Innovative project indeed..Please include Physicians from the Caribbean on your team.

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User

Julianna :P

Have you guys considered partnering with AI search engines for people looking up symptoms? Im not sure if enough people use them compared to regular search engines, but it might help speed up the process of expanding this idea's impact

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User

peter ke

an interesting and innovative talk ,

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