CHAPTER 7
ANOTHER ASPECT OF HOSTILE SURVEILLANCE THAT may lack the “romance” of surveillance against a terrorist team is the increasingly important area of public health surveillance. With the appearance of COVID-19 as a major factor in almost every aspect of national security there has been an understandable search for the data or intelligence about public health threats. This is the information that determines what requirements are imposed on businesses and individuals in resisting the threat of this new ailment. It also shapes public policy and the messaging that is used for encouraging compliance with those policies.
There are four basic aspects of surveillance associated with health problems. The categories are (1) infectious diseases such as COVID-19, (2) noninfectious diseases and health conditions, (3) risk factors, and (4) exposures. In recognition of these concerns, there has been an increase in surveillance-related grants and funding. The area for this surveillance effort is in clinical laboratories and the work is conducted by health scientists and medical doctors.
The starting point for this surveillance is notifiable diseases legislation. This legislation provides guidance about which diseases and conditions must be monitored. This surveillance constitutes the basis for reports that are issued and directed to agencies and entities that must respond. Clinical and laboratory-based surveillance is essential for determining the allocation of resources used to react to a health threat. It will also shape population-level prevention strategies that will be directed on a community basis. Because of the stigma attached to certain diseases, reporting on them may be done on an anonymous basis. Sexually transmitted diseases have long fallen into this category but, with the intense public fear of COVID-19, people who tested positive were ostracized by others. Public health laws identify the diseases that must be reported and designate the agencies with which their reports must be filed.
Surveillance strategies must take into account the privacy needs of individuals who could face discrimination if their health conditions became known. Those strategies must recognize their legal requirements regarding the privacy and confidentiality of medical data. Because of the frequent need for rapid response, clinical surveillance is needed to provide early warning about outbreaks of infectious diseases. The primary care provider who recognizes the signs and symptoms of a disease is the individual who will first recognize the appearance of a health threat.
Operating on the basis of the “notifiable diseases” list, the primary care provider will use whatever diagnostic aids are available to fulfill his surveillance requirements. This list is mandated by law, and it will change over time. The most likely diseases to be monitored are infectious diseases that can quickly spread, especially if that spread is facilitated by water, food, mosquitoes, or any other common vectors. Health-care workers are also concerned about any illness that can be prevented by vaccination and want to insure a rapid response to that need. They are also alert to identify sexually transmitted diseases, foodborne or waterborne illnesses, contagious diseases caused by airborne particles, and those like rabies or malaria that are transmitted by parasites. By 2015, there were requirements to report medical information in electronic claims data rather than in the previously less systematic fashion.