Taking lessons from COVID, Minnesota researchers will help develop response plan for next pandemic

CATHY WURZER: In the beginning of the pandemic, there was a feeling of whiplash. Health officials were continuously giving new and sometimes contradicting information on what we needed to do to stay safe and healthy. The pandemic brought a host of unknowns for all of us, including health officials. How was it spreading? Who was most at risk? What were the main symptoms?

Well, thankfully we have a better handle on COVID right now. But the US wants to make sure we're better prepared for the next outbreak. And health officials in Minnesota will be part of that work. The University of Minnesota and the Minnesota Department of Health have been awarded $17.5 million to help develop a national outbreak response network alongside the CDC.

Two of the three coprincipal investigators working on the project are with us right now. Dr. Adams Dudley is a professor in the University of Minnesota Medical School Institute for Health Informatics and School of Public Health. Kristin Sweet is Manager of Infectious Disease Cross-cutting Epidemiology, Programs, and Partnership at MDH. Kristin and Dr. Dudley, welcome to the program.

ADAMS DUDLEY: Thanks for having me.

KRISTIN SWEET: Thanks for having us.

CATHY WURZER: I'm going to start with Kristin Sweet. There are already, gosh, ongoing systematic processes that collect and analyze and disseminate data that's important to public health, right? How is what you're doing any different from what's already being done?

KRISTIN SWEET: Yeah, so we have great systems to do what we refer to as traditional public health. And it has grown over time as we've modernized our systems. So we're very good at tracking reports of disease when people are going through the routine system. So they're seeing their doctor. They're getting tested. The results are being reported to us.

And that's great when it works. And during the beginning of the pandemic, we saw some challenges with that when we didn't have enough testing. But then we moved into a phase where that worked really well. But what we have trouble with sometimes is figuring out, how do we describe things when that system can't capture everything, what we're seeing, when fewer people are getting tested, or when that's not getting reported to us, or some groups of people are less likely to get tested or are less likely to be reported to us?

And so these new techniques, new analytic techniques allow us to use different strategies, different tools, different information systems to measure things in different ways, which is really an exciting opportunity for us. So we can move into multiple ways of figuring things out, not just using the traditional sort of public health surveillance systems.

CATHY WURZER: OK. Dr. Dudley, what do you and others hope to learn? What lessons from the pandemic, which would you do you want to take into this new creation of a network?

ADAMS DUDLEY: Well, there are several important things. One was that what Kristin was describing where MDH figures out how many cases there are and things like that depends on the data that gets reported to MDH.

And historically, that has only been on patients who actually came to the emergency room, not urgent care, like your last-- you were discussing in your last segment, but the emergency room or people who are actually put in the hospital. And a whole bunch of COVID cases weren't sick enough to do either of those things.

And because we could only count the ones who were super sick, we made two mistakes. One's we thought there were fewer cases than there were. And two, we thought more of them died because we were only seeing the sick ones.

So one of the things we're going to do with this new system is extend our ability to monitor for symptoms into the people that-- the line of folks we're talking about, those primary care clinics and the urgent care clinics, even if people just call in, and try and get a better case count at the beginning so we can give people a much better sense of, how dangerous is this thing really?

CATHY WURZER: I'm curious, why didn't we have a system like this before? Anybody want to take that one?

ADAMS DUDLEY: Because--

CATHY WURZER: So I can say that--

CATHY WURZER: Go ahead.

KRISTIN SWEET: Oh, go ahead.

ADAMS DUDLEY: Sure, go ahead, Kristin.

CATHY WURZER: Go ahead, Kristin.

KRISTIN SWEET: OK, I was going to say we certainly try and bring in any new tools or systems that are available to us at any point during any disease response. But infectious diseases and modeling, really at least on the modeling side, were something that we were just starting to get into more and more.

We'd done some projects, more special sort of projects on it, not being used routinely in our surveillance work. And so the pandemic happened at a time where we really had new tools that we'd started to use but hadn't fully developed our use of.

And so Adams can speak to the HR consortium specifically. But for modeling and other things, we dabbled in those areas. And we tried to use them. But this was our first opportunity to really use them widely. And so it was exciting. And we got to try new things. But obviously, it's better if you can use systems that are robust and well developed, tested ahead of something like a pandemic.

CATHY WURZER: Ah, I see. Dr. Dudley, you want to make a comment about that?

ADAMS DUDLEY: Yeah, so historically for almost all of human history, infectious diseases were the thing that was dangerous and that killed people. So if you dial back the clock a hundred years, it's tuberculosis. It's polio. It's cholera. And it's the Spanish flu and things like that.

And then we got much better over the next 50 years at controlling infectious diseases. And we hadn't had a big pandemic in a while. And I think we sort of got a little bit complacent, to be honest, about the impact of infectious diseases.

And then what I was talking about, where you can find what's being reported to your primary care doctors in urgent clinics and even phone calls in, that only became possible when computer records got-- sorry, when health records got computerized, which started around the 2010s. And so we have been thinking, [AUDIO OUT] this-- the possibility that we can go through computers and find information since then.

But the truth is the focus wasn't on infectious diseases. It was more on the opioid epidemic or the suicide epidemic or cancer and the kinds of things that over the last 50 years had become the big killers of people. And it took a pandemic for us to realize, oh, well we ought to do this and for society to give us permission to do that.

CATHY WURZER: I see. So I'm wondering, your friend, your maybe not a friend, but colleague Dr. Michael Osterholm--

ADAMS DUDLEY: We're friends.

CATHY WURZER: --Dr. Osterholm, of course, always says, it's just a matter of time until the next pandemic. And I'm wondering, can you get this system up and running before the next big one hits, Kristin?

KRISTIN SWEET: So we never know when the next big one it's going to hit. It depends also what you define as a big one. But in my time, we've had several big responses, not all at the level of COVID, obviously, nothing at the level of COVID. But we have had H1N1 influenza that was emerging at a time and other things. So I'm hopeful that we can have some things in place that would at least make it easier and faster to roll out some of these tools.

And hopefully, for all of our sakes I hope that we have this-- a break now before we have something else of this scale or even a smaller scale to respond to. But, certainly, our priority is getting some quick tools going as quickly as possible so we can have those tools ready and then move forward with developing some more sophisticated and advanced tools that we can use and, hopefully, have plenty of time to get those out and going before we see anything like this again.

CATHY WURZER: Last word, Dr. Dudley?

ADAMS DUDLEY: Well, I think in Minnesota we're way ahead of the rest of the nation. So I'd be very surprised if we don't have this system up for monitoring in primary care clinics and urgent care clinics in the next two years, we don't have something-- you don't know what the next disease is going to look like. But we can test it out as if it were COVID and the same as COVID.

But that's very different from the rest of the world. So in Minnesota, we have worked really hard. MDH has been super important in this in bringing the health systems together and having them figure out how to share health data across health systems by having each health system add up all their data on individual patients, sometimes down to the zip code or county level, but not individual patient data. So there's no privacy issue here.

But we've been doing that for years now. And the rest of the country just hasn't. So we'll be ready, I think, within the next couple of years to respond very differently. But then we'll have to show the rest of the country how to do it.

CATHY WURZER: All right. I appreciate your time. And good luck. Thank you.

ADAMS DUDLEY: Thanks. Thanks for having us.

KRISTIN SWEET: Thank you.

CATHY WURZER: Dr. Adams Dudley is with the University of Minnesota. Kristin Sweet is with the Minnesota Department of Health. Both are helping to create a new national outbreak response network.