COVID-19, Data-Driven Insights, and John Snow
by Chris Bowen
Chief Privacy & Security Officer and Founder
Earlier this week some 45,000 healthcare and life sciences professionals were to descend upon Orlando for a week of intense learning and sharing as part of HIMSS20. Late last week, Hal Wolf, President and CEO of HIMSS did what leaders have to do – he made a tough call and cancelled the conference.
I applaud Hal. The work required to stage a conference of this size is tremendous, and it’s a complicated – and controversial - thing to close the doors on it for many reasons. However, the fact that HIMSS’ attendees are healthcare providers and other professionals adds another layer of concern about large group exposure, community spread, and possible pending quarantine from COVID-19. These healthcare workers - whether they are providers, nurses, researchers or healthcare IT - are desperately needed in their communities to help combat the spread of this virus and to tend to those who have contracted it. And, we need them capturing and capitalizing on the massive droves of data healthcare is accumulating to drive data-centric innovation and behavioral change and stop this critical contagion.
It is dangerous to be too alarming and it is dangerous to be cavalier. Monday, the New York Times reported “U.S. health experts say stricter measures are required to limit the Coronavirus’ spread” as we see almost 600 cases spreading through 2/3 of the states. Experts are planning moves from containment to mitigation, warning that social distancing is necessary especially for elderly and/or those with underlying conditions. Experts such as Dr. William Schaffner from Vanderbilt told the Times “one goal of mitigation is at least to slow down an epidemic. If you can stretch things out long enough, you buy more time for the development of the vaccine and the research to be done for treatments.”
With advances in machine learning and AI on the cloud, we do have the potential to innovate swiftly to that end at a scale that was previously impossible. And that’s good news. Data holds the key to getting in front of this virus.
Even smaller data projects have paid off in the past. Recall the horrific outbreak of Cholera in London’s Soho District in 1854. English physician John Snow (who later become one of the founders of modern epidemiology) advocated that the conventional wisdom of the day – that cholera was caused by “miasma” or breathing “bad air” – was in fact not accurate. Snow had published an article in 1949 prior to the outbreak stating his belief that cholera was caused when public water sources became contaminated with germs caused by sewage – a very real concern in the rapidly expanding and densely settled regions of London, such as Soho – where sewage was dumped into rivers and where cesspools under homes were sometimes only feet from water pumps and wells.
To test his theory that cholera was caused by contaminated water, Snow created a map (see Steven Johnson’s book Ghost Map for a deeper dive) and pinpointed where each death from that outbreak had occurred. He held that people would drink from water sources near their homes. He found that within 250 yards of the intersection of Broad Street and Cambridge Street there had been 500 fatal cases of cholera within a ten-day period. He suspected the pump at Broad Street and worked tirelessly to track activity around the pump’s use. With his data points on a grid, all signs pointed to the deaths being caused by contact and use of the Broad Street pump. This flew in the face of the standard belief of the day, so Snow also tracked down people who had not gotten cholera in the general vicinity and identified their water sources to rule out other possible sources of the outbreak. His work uncovered men working at a brewery who did not get sick (they used the brewery’s own well) and inmates that drank from their prison’s well. He found one puzzling outlier in the deaths– a woman and her daughter who seemingly had no contact with Broad Street water pump but then discovered the woman and her daughter used to live in the area and liked the water, so had it delivered to them in their new location. They drank the water pulled from the pump and both died a day later.
Now armed with conclusive data, Snow convinced the town officials to remove the guilty pump’s handle on September 7 – thereby making it impossible to draw water. The outbreak ground to a halt. He eventually traced the issue to a cholera infected baby diaper cleaned three feet from the Broad Street pump which leaked into the water supply, ultimately killing more than 600 people. It still took an incredible amount of time for the general public and lawmakers to buy into Snow’s theory about cesspools, but today there is no argument about sewage contaminated water causing cholera. Sadly, there are still outbreaks of cholera, especially in poor countries where the populations have unacceptable sewage treatment and clean water.
There are parallels to be drawn from this aged tale of cholera. Rather than accept “miasma” as the cause, Snow dove into the data and fought hard in his research to get to the source of truth and the source of cholera prevention. He used data to move swiftly to save lives.
Today, all of us in healthcare must take up the same fight and use the data we have to get to the answers fast on preventing the spread of COVID-19. But we have to do so responsibly and within security, privacy and compliance frameworks to protect patients.
When I founded ClearDATA, my vision was to create a company that would enable healthcare to innovate safely on the cloud by protecting patients’ sensitive data. We at ClearDATA are doing this today. We help our customers keep their own massive data sets secure and within important compliance frameworks while they innovate to build new apps, make new discoveries, or - in the case of COVID-19 - to hopefully speed discovery that prevents further spread of this virus and helps create a cure for those who have contracted it.
As an industry, we have massive data within our reach, and we must use it – safely and wisely – to accelerate and protect community health.
Visit our COVID-19 Resources Center to learn about solutions our customers are developing in the fight against COVID-19.