WebEx Technology Allowed for Instant Polling and Q&A Using the Internet
Discussing a threat at the top of today's public health agenda, Dean Barry Bloom launched the first HSPH web seminar, or "webinar," on May 16. "Bird Flu: Public Health and Pandemics" drew 110 registered participants, including an international audience electronically connected from China, South Africa, and elsewhere. They represented various interests, including food services, academe, small businesses, and the pharmaceutical industry. Aided by a popular conferencing technology known as WebEx, the participants heard Dean Bloom's presentation on the telephone while simultaneously viewing his slides on their computer screens. They also were able to take part in a live online question-and-answer forum. The webinar was organized by the Office for Resource Development.
There have been ominous developments in the spread of the H5N1 avian influenza virus, a virulent strain that scientists fear could adapt to human biology and trigger the next deadly flu pandemic. As Dean Bloom noted, more than 200 people have already been infected with the bird virus, and at least 113 have died: a case fatality rate approaching 50 percent. (Since the May 16 webinar, a cluster of avian influenza cases was detected in a family in Indonesia. As of June 20, the last person to die in that cluster passed away on May 22. WHO, the U.N.'s Food and Agriculture Organization, and the Indonesian Ministries of Health and Agriculture planned to jointly convene an expert consultation in Jakarta from June 21 to 23.)
What would a global H5N1 human outbreak look like? For historical comparison, consider the 1918 flu pandemic, one of the towering scourges of all time. That virus killed 40 to 100 million people within six months. Globally, four percent of victims died; in the U.S., 25 percent of civilians were infected, and a half percent of the population succumbed to the disease.
"The relevant point here," said Dean Bloom, "is that the 1918 virus, which was so devastating, was a bird flu strain."
Modern life makes today's circulating bird flu even more frightening. The world's population is three times greater than in 1918. National borders are porous, with 1.1 million travelers crossing into the U.S. every day. And the close proximity of humans, poultry, and pigs in Asia is a recipe for the viral genetic transfer that could lead to human transmissibility, Dean Bloom explained.
If H5N1 did easily spread person to person, the toll would be almost incalculable. Quoting federal estimates, Dean Bloom described several possible scenarios: how up to 200 million people in the U.S. would be infected; 40 percent of the workforce would stay home; 18 to 42 million victims would need outpatient care; up to 733,000 people would require hospitalization; and two million Americans could die.
Though antiviral drugs and palliative measures would buy time, the only effective response is a vaccine. But according to Dean Bloom, our capacity to make such a vaccine is years away-a state of affairs that stems from indifference to public health realities. "Scientists in the government in 1991 prepared the first inter-government task force plan on pandemic influenza," he said. "No action was taken on that plan until three weeks after [Hurricane] Katrina, when it was pulled off the shelf. The essence of public health is prevention, and we were asleep at the switch for a period of almost 15 years. We would have had vaccines by now, had somebody mobilized what government scientists were saying at the time."
The WebEx technology allowed Dean Bloom to take an instant poll of participants on two questions: "Does your place of business have someone assigned to plan for an influenza epidemic and/or manage logistics in the event that one does occur?" and "Do you own or work with poultry or other types of birds?"
To answer participants' online questions in the latter part of the broadcast, Dean Bloom was joined by Paul Biddinger, director of the scientific core at the HSPH Center for Public Health Preparedness. Among the concerns relayed online by the seminar's far-flung participants: Should medical providers and businesses stockpile antiviral drugs such as Tamiflu? (No, because overuse of these precious medications could render them useless.) How should families protect themselves against a pandemic? (Depending on the age of family members, the following steps should be considered: Get the seasonal flu vaccine, which may offer cross-immunity, and the pneumococcal vaccine, which prevents bacterial lung infections; if there is a fear of transmission globally, stock up on canned goods and water; and wash hands frequently.) How would employers screen for infected employees, prevent absenteeism, and prevent the workforce from being overly affected? (There is no effective screening because of the unique characteristics of the influenza virus. Unlike SARS, influenza can be transmitted before symptoms appear. One possibly effective measure is to encourage at-risk people-those who have come in contact with influenza patients-to stay at home until they no longer can be harboring the virus. Employees who are ill should be encouraged to stay home.)
Take Advantage of WebEx Conferencing Technology
SPH Information Technology has kicked off a six-month pilot of a web conferencing technology called WebEx. The technology allows for an individual or group to present information orally over the phone while transmitting data files, such as PowerPoint presentations, over the web. There is also a feature for participants to post questions and comments online that the group can see.
"For the end user, it's really easy," said Deane Eastwood, Manager for Instructional Computing and Application Development at HSPH. "They just make a telephone call and click on a link in an email to start the web portion."
The "Bird Flu: Public Health and Pandemics" webinar described above was the first use of the technology at HSPH.
HSPH plans to use WebEx not only for informational seminars, but also for academic collaborations. It enables researchers to host online meetings of colleagues across town-or across the world. "People could work on grant applications together, they could work on projects, they could even create PowerPoint files together," said Eastwood. "We see an increasing number of faculty and staff working at home or from hotel rooms or abroad. This is a way they can share applications."
For more information on using WebEx, contact Deane Eastwood.
—MD
Copyright, 2009, President and Fellows of Harvard College
