The Muse: A tale of two crises

We are in the midst of two public health crises with very similar underlying foundational issues. What I clearly see is we have lost the ability to scale our public health system to meet large scale public health crises.

Alan Rudolph at Colorado State UniversityAs the Ebola crisis in Africa spilled over into cases in the U.S. it became clear that our public health system was not adequately prepared to respond. This was manifest in many aspects of the fundamental elements required to mount an effective response, including containment facilities; hard policies on quarantine; adequate training and practices for health care responders; effective diagnostic and medical countermeasures including vaccines and therapeutics; and effective communication procedures. Improvement across all of these elements would alleviate the concerns of the worried well and provide a platform for accurate mass media coverage. For a contagion with a high mortality rate such as Ebola, this is an acute public health crisis for which we have no effective response.

Of most concern was the realization that if the virus had not been contained in the U.S., we would not be prepared to adequately serve those who may have been exposed or become sick, or to effectively manage the large amount of medical waste and biohazardous biomass generated by the sick and dying. And this does not even begin to address the potential health-care worker absenteeism that would further strain the system in the face of such an increased threat of contagion.

While Congress debates a multibillion-dollar investment in response to the Ebola outbreak, it is clear that one of the areas that will be front and center is the expansion of our ability to scale public health response. One focus of such investments will be the enhancement of containment facilities in hospitals across the U.S. Even with increasing attention to antimicrobial resistance in hospitals with rising threats from MRSA, and the concomitant increase in requisite containment infrastructure, our public health architecture will struggle to respond to large-scale outbreaks and the potential of thousands if not millions of sick people in need of critical care.

Campus mental health

A second public health crisis that has not been managed effectively is playing out on campuses across the U.S. It is manifesting with similar numbers, but on a timescale that is hardly observable in the context of the Ebola crisis. The mental health crisis in our young population is a chronic public health situation that touches a startling number of students on U.S. campuses.

The statistics summarized at a recent Association of Public Land-grant Universities (APLU) meeting in Orlando are startling. Over 80 percent of students surveyed on campuses report severe stress levels with a majority reporting feeling overwhelmed. The result is a significant rise in the numbers of students accessing campus health-care systems and, of most concern, an alarming rise in suicides. Tragically, CSU has not gone untouched by any aspect of this crisis.

In response to this insidious public health emergency (or predicament), campuses all over the country have increased their investments in scaling the health-care system, including adding counselors and programs, to meet the growing demand. Nevertheless, there is considerable discussion as to whether we will be truly able to adequately meet the requirements of this crisis. Of gravest concern is that the most severely affected often do not access the system.

These two divergent but related situations suggest that scaling our public health system will have to come from new ways to meet the rising demands of both acute and chronic public health care crises. In contemplating the increasing potential for technology to play a role in public health response, it seems addressing the common issue in both these cases requires attention to how to deliver effective health care with reduced human workforce and how best to insert systems that can reach those who have yet to reach out for information or care.

Automation answer?

One avenue recently under exploration involves the increased use of automation, robotics, and information systems. Advances in other sectors, such as electronics, aerospace and automobile manufacturing, provide ripe opportunities to employ increased automation in hospital settings for tasks currently performed by health-care workers. Critical functions such as patient bathing and cleaning could be automated to limit health-care worker exposure to highly contagious patient effluents. Decontamination of hospital surfaces and facilities could also be automated using robotics, thereby further decreasing the spread of contagion.

Notably, the upcoming International Conference on Robotics and Automation in Seattle includes several sessions on automating the public health system with robotics and automation. Many of these ideas could also have workforce application in the Biosafety Laboratory System, again reducing workforce needs and increasing safety.

Similarly, the application of automated systems to chronic mental health issues in our student population is an opportunity to envision how we can expand care to students without simply adding counselors. One avenue of exploration is the use of internet portals, pushes, social media, and artificial intelligence in smart devices that could reach students suffering from mental health issues such as stress, anxiety, and depression.

CSU is at the forefront of this innovation by holding student forums to test such systems. In addition, we have instigated discussions between CSU researchers and the Office of Student Affairs to further explore possibilities in using electronic measures to facilitate novel solutions for meeting our community’s expanding health-care needs.

Recognizing the similarities in these two crises offers opportunities in research and discovery and its translation into useful technologies. Although there is potential for these opportunities to improve public health outcomes, it is important to realize that technology solutions alone are unlikely to result in complete solutions. Individually, each crisis in its own right demonstrates the vulnerabilities of our current public health infrastructure and the urgent need to advance innovative solutions.

Alan Rudolph is the Vice President for Research for Colorado State University.