Fighting Influenza with Data

Post by: Kim Stephens

The Boston Mayor has declared a public health emergency due to the deadly flu outbreak that has killed 18 people to date.  Public Health organizations are pulling out the stops to communicate protective action information to the public and social media is just one of the tools in the toolbox. The public, however, is also using social media to talk about the flu. They state such things as whether or not they are sick; whether or not they had a shot; and “Google” what they should do after they become ill, just to name a few of the topics of conversation. People can even download a new Facebook app titled “Help, My Friend Gave me the Flu” to figure out who they need to blame for feeling miserable. (As an aside the app is actually quite cool. After you give it permission to access your newsfeed it looks for key words from friends that have posted content related to feeling sick. From a public health standpoint, if people know some of their friends are ill they might be spurred to get a flu shot, or at a minimum keep their distance. I’m happy to report all of my friends are healthy!)

All of this web and social data, in turn, is being “mined” by public health organizations and researchers in order to determine both the geographic spread of the virus, as well as the rate of infection. Some organizations are also asking the public to self-report how they are feeling. Below I outline five tools that are interesting aggregators of social flu data.

1. FluNearYou is a tool that allows the public to participate in tracking the spread of flu by filling out a survey each week. The survey is quite simple and asks the respondent if they have had any symptoms during the past week and whether or not they have had the flu shot either this year or last year. Respondents can include family members and the questions are asked about each person individually. This user contributed data is then aggregated and displayed on a map with pins that are either green for no symptoms, yellow for some  and red for “at least one person with Influenza-like” symptoms. The pins are clickable and display the number of users in that zipcode that have reported their condition, but no personal information whatsoever. The number of participants in the state is displayed (1294 in Massachusetts) as well as locations and addresses where people can get vaccinated. Links to local public health agencies are also provided. People can also sign up to receive location-based disease alerts via email. Social sharing of the site and its content is encouraged by the addition of prominently placed social media buttons.

This site is administered by Healthmap of Boston Children’s Hospital in partnership with the American Public Health Association and the Skoll Global Threats Fund.

2. Google Flu Trends is another site that provides geographically based information about the spread of the influenza virus. Their data is aggregated from the search terms people are using versus self-reporting. In fact, the graph of the tracked searches (see below) related to the flu compared to the actual reported cases of the virus is so close that they almost overlap.

Google explains how this works:

Each week, millions of users around the world search for health information online. As you might expect, there are more flu-related searches during flu season… You can explore all of these phenomena using Google Insights for Search. But can search query trends provide the basis for an accurate, reliable model of real-world phenomena?

We have found a close relationship between how many people search for flu-related topics and how many people actually have flu symptoms. Of course, not every person who searches for “flu” is actually sick, but a pattern emerges when all the flu-related search queries are added together. We compared our query counts with traditional flu surveillance systems and found that many search queries tend to be popular exactly when flu season is happening. By counting how often we see these search queries, we can estimate how much flu is circulating in different countries and regions around the world. Our results have been published in the journal Nature.

In fact, the current flu trend data for Massachusetts reflects the declared state of emergency. (See also this article: Widespread Flu has public logging online.)

3.  MappyHealth is another tool that tracks keywords related to health but instead of using data from searches in Google, this system utilizes the Twitter data stream. Their stated reason for the site: “It is hypothesized that social data could be a predictor to outbreaks of disease. We track disease terms and associated qualifiers to present these social trends.” Although this blog post is focused on influenza, the MappyHealth site tracks 27 different categories of illness. They explain how all of this is done on their FAQ page.

The graph below displays Tweets by the hour and day that are related to influenza. The last full day on the chart is January 9, which shows a significant spike in the number of Tweets on the topic.

What is everyone talking about? The user can actually see the individual Tweets by clicking on any point on the graph. The associated Tweets then populate a table beneath the graph (profanity and all). The table includes the time, tweeter, complete text of the tweet, location (if available) condition match and qualifier match. The last two terms need a little bit of explanation. If someone states “I don’t have the flu” the condition match will state “flu” but the qualifier will state “don’t.” Location data is not included in all Tweets, however, MappyHealth does provide a sorting mechanism by location for those that do, and this content is displayed on a map.

Another feature on the site includes a link to a “Realtime Twitter Search.” This link takes the user to an advanced search MappyHealth has already created that includes many different keywords Tweeters  might use when talking about influenza, including: flu, influenza, h1n1, h5n1, H3N2, adenovirus, etc. This search is available for every illness category. This feature alone is worthy of a bookmark.

4. Not to be outdone, the Center for Disease Control has released a Influenza smartphone application. The intended audience is clinicians and other health care professionals, with a stated purpose of making it easier to find CDC’s latest recommendations and influenza activity updates. Some of the reviews, however, point to a few problems, such as dated information on flu activity.

5. HealthMap.org was involved in the design and development of “FluNearYou” and therefore has a similar look and feel to it. However, the site does have a very different process for gathering data. HealthMap states that they

“…bring together disparate data sources, including online news aggregators, eyewitness reports, expert-curated discussions and validated official reports, to achieve a unified and comprehensive view of the current global state of infectious diseases and their effect on human and animal health. Through an automated process, updating 24/7/365, the system monitors, organizes, integrates, filters, visualizes and disseminates online information about emerging diseases in nine languages, facilitating early detection of global public health threats.”

HealthMap.org also has a mobile application that includes all of the features found on their website, but I actually find the app easier to use. Using the smartphone’s touch-screen-zooming capability makes it is easy to hone in on specific locations and view all of the associated alerts. The alert content, however, is a bit heavy with information from traditional media.

+1. #FluChat: News organizations are not only providing the public with information about the effects of the influenza virus this year, some are also providing a public health awareness function via their presence on social networks. On Thursday, January 10th, for example, a #FluChat was sponsored by @USATodayHealth.

Have questions about the flu? Tweet them using #fluchat and we’ll get you answers at 3 p.m. ET today.

— USA TODAY Health (@USATODAYhealth) January 10, 2013

Health based Twitter chats offer the public the opportunity to post questions that are addressed by healthcare professionals or researchers. The CDC, for instance, has conducted many chats on a wide variety of topics. Watching the questions that are posted in these chats offers local public health organizations an opportunity to “hear” the concerns of the public. Knowing this information can help with message formulation and coordination. Here are a few questions posted to the #fluchat:

https://twitter.com/SellOrElse/status/289423264302895104

@USATODAYhealth #fluchat What are the benefits of getting a flu shot besides keeping you well?

— Miss Giggles (@AndreaKcc) January 10, 2013

https://twitter.com/sgt1917/status/289424324937527296

Bonus: Reviewing the #fluchat stream I found “A Flu With a View” from Sickweather.com. This visualization of flu data comes from a process they use to filter Tweets, Facebook updates as well as self-reporting on their website. They state: “This amount of real-time data, combined with historical data from the CDC and Google Flu Trends, is what gave us a crystal-ball-like view of the flu this year. In fact, our data of flu season to date shows that we are still near the peak of flu season, but possibly (hopefully) starting to level off.”

See this visualization:

None of these tools will help people feel better once they are already stricken with the virus, but they might alert the public to how prevalent the virus is in their community and possibly persuade folks to take preventive measures. Tell me what you think. How could your agency put this information to use?

This post was also placed on the WMASMEM.wordpress.com blog.

#SMEM Challenge for 2013: “I don’t get it.”

Post by: Kim Stephens

Image by: nglcc.org

An interesting dilemma for social media and emergency management advocates is how to convince the inconvincible. Inevitably at in-person meetings, forums as well as on-line, there is always someone in the crowd that raises their hand and states “I just don’t get it.”  These doubting Thomases are typically folks who do not use these tools for personal communication and have only  heard (or care to listen to) negative information about social networking.

• “The only thing on social media is rumors.”
• “It’s not appropriate for public health organizations to be on social media because of HIPPA.”
• “Why should I  learn these tools? After a disaster the communications infrastructure will be destroyed rendering social media useless.”

and my all time favorite…

• “The only thing on social media is what people had for lunch. Why would I care about that?” (Although, I have to admit, my sister-in-law does tend to post a lot of pictures on Facebook of her cooking.)

This type of sentiment was recently brought to my attention while helping promote the new Accessibility Toolkit. The online wiki “…was developed to empower people with disabilities to use social media for disaster preparedness, response and recovery. This toolkit was developed in response to the fact that not all people with a disability are able to access life saving messages delivered through social media due to the accessibility challenges that the tools currently pose for people with disabilities.”

The promotion of this toolkit was placed on many different blogs, including this one, and in an online forum on LinkedIn.  A first responder, who also stated that he was a long-time time ham radio operator, provided a comment that perplexed me. The comment does, however,  encapsulate the attitude I described above.

I would think that these people with disabilities want to be taken to a safe place and not bother with U tube, twitter, etc. We live in a push button world and now people are lost when the buttons don’t work. My work is SAR (Search and Rescue) and to be honest with you in the last few days I spent to much time on this lap top when I should getting my winter SAR pack together. You have SAR teams, EMT’s, fire rescue, water rescue and even volunteers helping. I think it’s sad to see real people turn to an electronic device for helping them. When everything goes out you have us and I don’t think that will ever change.

I honestly would not have even of known where to start in terms of crafting a response to this gentleman. He obviously cares about people and helping them, but didn’t see how social media could play any sort of role in that effort whatsoever. However,  Eileen Culleton, the Founder and CEO (Voluntary) of the Emergency 2.0 Wiki,  was able to craft a beautiful response. And although her reply mostly points out the benefits of the wiki, I plan to borrow heavily from her statements next time I encounter someone that says: “Social media? I don’t get it.”

Hi, firstly, I’d like to introduce myself. I am the Founder and CEO (voluntary) of the Emergency 2.0 Wiki, which was established by Gov2qld (a community of practice of professionals working in the Gov 2.0 space) after the devastating floods of Queensland and Cyclone Yasi in Australia last year.

I’m not a first responder or CERT or SAR volunteer, or a tech guru. My background is marketing and communications for not for profits, business and government, as well as more recently working in ICT change management for local government and helping them to setup and engage in social media (including for emergencies).

But I do know how it feels to be a disaster survivor. As a child I survived the most devastating hurricane to hit Australia – Cyclone Tracy that struck Darwin, in the Northern Territory, on Christmas Eve in 1974. My family lost everything… our home and contents including our precious pets and family photos.

That was before social media existed, but ham radio did… and I will never forget that when the communications infrastructure was destroyed, due to Darwin’s isolation from the rest of the country, for hours no one knew the cyclone had struck and that a city needed help.

Photo: Australian EM Institute

But, it was a ham radio operator, like yourself, that sent out the SOS call to the world. This was one of the factors that sparked my inspiration for the Wiki. That example of community resilience, in which a member of the public, aided by technology (ham radio) and his networks got help for a city that was so devastated its women and children were evacuated in the biggest airlift that Australia has ever seen.

And now today, thanks to the instant, amplifying power of social media and our networks, we all have that power to save lives… our own lives, and the lives of others. And that includes people with a disability, if we can help them overcome the accessibility challenges that social media currently poses. That is why the Emergency 2.0 Wiki Accessibility Reference Group, of professionals from a diverse range of industry sectors, have joined together across the globe, as volunteers to create an online toolkit and post it on the Wiki to share with the world. They are committed to building resilient communities, wherever we are.

First responders can’t be everywhere. Search and rescue volunteers can’t be everywhere. We, as a community need to use technology to empower ourselves so that we can get out of danger… and that includes people with a disability.

Once they overcome the accessibility challenges of social media, (with help from the tips on the Wiki), people with a disability, like the rest of the public, will be able to receive emergency alerts in real time and take action. And they can also, like the rest of the public, reach out and warn others of danger…

And they can reach out, locally, and globally, to help others impacted by disasters, by using social media. I encourage everyone to take the time to read this blog post by a woman in a wheel chair in Boston, who helped keep a man alive, who was on a ventilator in New York, impacted by power outages from Hurricane Sandy… by using social media to reach people to help. [You can also listen to some of this story which was broadcast on Talk of the Nation on NPR, November 1, 2012: “Sandy Especially Tough on Vulnerable Populations.”]

Photo of Nick Dupre. Source: http://littlefreeradical.com/2012/11/04/unconventional-aid-helping-nick-dupree-part-ii/

I respect the contribution you’re making helping others through your volunteer work with SAR. I ask that you please respect the contribution the Emergency 2.0 Wiki volunteer community is making to help empower people, including with disabilities, to use social media to help themselves and others better prepare for, respond to and recover from emergencies. If you want to learn how social media can help your SAR volunteer work, the Wiki can help. If things are missing, please let us know. But remember, we are volunteers, just like you. We need you to help us, help you, to help others.

Best regards, Eileen

Well said Eileen!

Related articles

• Top #SMEM Challenges for 2013: I Don’t Have Time! (idisaster.wordpress.com)
• Social Media Accessibility Toolkit: New from Emergency 2.0 Wiki (idisaster.wordpress.com)
• Social media changes disaster response (brucehensler.typepad.com)

Washington Smoke Blogspot: A Truly Collaborative Effort

Post by: Kim Stephens

Smoke from the September 2012 fires in central Washington State continues to cause huge air quality concerns for local residents.  Last week public health officials, according to the Seattle Times,  went so far as to call conditions  “…worse than in the days after Mount St. Helens erupted and the region was coated with ash.”  Not surprisingly, this has manifested in very real public health problems and has led to hospitalizations and school closures.

“We have never had anything like this happen in Chelan or Douglas County and maybe never in the state of Washington,” said Mary Small, public-information officer for the Chelan-Douglas Health District. (Source: http://seattletimes.com/html/localnews/2019205184_wenatchee20m.html)

As with any crisis, citizens want to know what is happening and how it impacts them. But in this era of information overload, feast is sometimes more of an issue than famine. This is especially true now that every  locality, State and Federal agency has a website, a blog, a Facebook page, a Twitter account, etc.

Of course the Joint Information System is supposed to address this problem. In theory the JIS is designed to “integrate incident information and public affairs into a cohesive organization designed to provide consistent, coordinated, accurate, accessible, timely, and complete information during crisis or incident operations.” But, we all know this doesn’t always happen as seamlessly as the definition implies.

Washington Smoke Blog

The Washington Smoke Information blog, however, provides a great example of what a cohesive information  system can and does look like. According to the USDA’s Forest Service website, the blog combines information from numerous agencies including Washington State Department of Ecology, Washington State Department of Health, Washington tribes, U.S. Environmental Protection Agency, U.S. Forest Service and various Washington county health departments.

“This website [blog] is a big step forward in providing the public with one-stop information that will help them protect their health,” said Deputy Regional Forester Maureen Hyzer. “We recognize that smoke from wildfires is a big concern for the public. This site will help them get information quickly about the air quality where they live.”

VOST

Of course a website or a blog doesn’t coordinate information, people do. One interesting aspect of this blog is that, according to the USDA-FS website, it was put up with the assistance of  “a volunteer web group.” The volunteer-web-group is actually a Virtual Operations Support Team or VOST (see definition in the text box).

The Forest Service has been making use of VOSTs mostly due to the promotion and deployment of the concept by Kris Eriksen, the Public Information Officer (PIO) for the National Incident Management Organization (NIMO) Portland Team (a Type I Incident Management team). Ms. Eriksen has utilized VOSTs since 2011 to support social media and digital communications on numerous fires. The effort was documented by researchers during the 2011 Oregon, Shadow Lake Fire (read that document here.)

Who are these volunteers? Participants in this VOST effort include active emergency mangers who work during their off hours, people who have technical skills and an interest in emergency management, and even some regional forest service employees. Most have worked on previous VOST efforts.

Tools for Organization--With each VOST activation Ms. Eriksen and the team make use of Skype chat rooms and Google Docs to coordinate their efforts. Both communication and collaboration tools are seen as vital to the success of any deployment. The skype platform allows information to be relayed from the official organization via Ms. Eriksen to the VOST members in a text format: members can simply read the stream in order to determine what has transpired in previous communications and/or shifts. They also use the tool to discuss issues and receive direction in real-time. (I was given access and permission to read through the chat log.)

The Blog

In order to ensure citizens can quickly find the information they need, the Washington Smoke blog was designed–as stated above–as a one-stop shop. How do the volunteers fit in? It should be emphasized that VOST members are not involved in any of the following: decisions about what is posted; deciding if air quality is good versus hazardous; the wording on a press release or even the titles of the categories on the blog. They are, however, integral to the effort to pull content generated by official sources to the blog and populate the site with links and data from those sources as directed by the team leader.

Google Crisis Response

When citizens link to the blog site the first thing they will see is a prominently placed Google map. This map has multiple layers of data including: air quality–current conditions; air quality–tomorrow’s forecast; schools affected by the smoke; public alerts; Active Fire Perimeters; Inciweb (Incident Information System) fires; US Radar (Precipitation); and Cloud Imagery.

The Google Crisis Response Team worked very closely with Ms. Eriksen and the VOST  on this effort to provide a map that would help meet information needs of the local citizens.   Animation layers were added based on data available through actively participating organizations such as the Washington State Department of Ecology and the US EPA–just to name two. (I understand that getting the data into compatible formats was a little bit of a challenge.)  Although each organization has their own website to provide agency-specific content (see–Air Now a site that has Air quality information displayed on a map) , the Google map is the only place to find layered data: for instance, you can find schools within the hazardous air quality boundary.

Other information available on the site:

• A map that is hyperlinked to National Weather Service real-time updates (labeled: Watches, Warnings and Advisories–the grey color indicates an air quality alert);
• Daily updates of air quality from each county with the measures Good, Unhealthy, Moderate, Unhealthy for senstive groups and Hazardous;
• Daily updates or press releases from any organization involved in the response. Yesterday, for example, there were posts such as:
  • 9/26/12 0900 Clean Air Shelter Open
  • 9/26/12 ECOLOGY NEWS RELEASE: Smoke creeping back…
  • 9/26/12 Wildfire Smoke Forecast 0800 PDT
• A list of all of the hyperlinks to pertinent agencies, organizations and tools separated by categories including: County, State, Federal, Webcams, and Fire Information (which includes such sites as Inciweb and the Northwest Interagency Coordination Center);
• FAQs;
• Other resources;
• Information in Spanish

According to the site-visit counter the page has received over 25,500 hits. That is a great success. I look forward to the after action report from this effort. I think there will be many great take-aways for other communities and agencies to learn from–for instance, the importance of sharing data in open formats. What do you want to know more about?

Related articles

• How bad is it? Experts say take smoke levels seriously (wenatcheeworld.com)
• Wildfires spread smoke through Inland Northwest (krem.com)
• Thousands of face masks distributed in Wenatchee (krem.com)
• Smoke from Oregon, Washington wildfires continue spread over areas (oregonlive.com)
• It’s this smoky in eastern Washington (ridenbaugh.com)