Unexplained periods of higher death and medical admissions have been characterised in the UK. Both deaths and medical admissions appear to show spatial spread indicating a potential infectious aetiology.
A quick overview of this research is available at:
http://www.hcaf.biz/emergencyadmissions.html
The actual analysis is relatively simple and is not time consuming and the spatiotemporal spread of the agent is best demonstrated using very small area data.
If you are interested in conducting research outside of the UK I have a draft paper which demonstrates the current approach and the type of results which can be observed. If you contact me by email ([email protected])I will send a copy of this draft paper and hopefully these outbreaks can be demonstrated far more widely than the UK.
#HoldIt!
Is there any syndrome identified? (cough? diarrhea? fever?) is it sudden? How much info are the chart? are there autopsies? what is the coroner opinion?
Death and admissions alone are not enough to say anything... more information and some suggestions are required to begin an investigation... I would be involved... I'll write you later today...
Hi Hedley, A collection of diagnoses roughly consistent with immune function disruption (infection, inflammation and autoimmunity). Currently not a recognised disease, hence, no autopsies, etc. Only surges in deaths and admissions with no explanation. To get a quick overview look at the abstracts of the papers on my website. Start at the most recent first.
Rodney,
Fascinating situation. I've shared this with my Twitter network that is mostly oriented toward emerging diseases, One Health, global health, etc. I hope it will generate some interest. Best wishes on this, and thanks for sharing it.
Bruce
I have a draft document I can share, it has been submitted to a journal, so I cannot load it directly onto the website. However, it shows these outbreaks using very small areas called lower super output areas (LSOA) which contain around 1,500 population. Spread between areas is relatively slow which is why these outbreaks have been missed for so many years. However very large increases in emergency medical admissions are observed when a small area is badly hit. A paper comes out in 10 days showing something similar in Australia. http://ijer.skums.ac.ir/article_12869_0.html
Yes, the idea appears interesting. SIRS may present in ways that may be infectious or non infectious. Both are important and deserves investigation. I am ok with your concept. Can I have the draft paper?
Hi Partha, Send an email to [email protected] and I will send a copy. Cheers Rod
Dear Rodney,
Yes I would like to research on new outbreaks, how do we connect?
Rodney,
I believe you are looking at natural variation in all-cause admission and and all-cause death rates, and for some reason, assume there must be some common cause?! What is the precise definition of the entity that you think might have a common cause?
As for causes of admission or death.. the list is endless: common colds, flu, food bugs, road traffic accidents, domestic accidents, violent crime, hospital acquired infections, staff moral, drug availability, demographics of different locations, immigration, wars... It is exactly because of this multitude of causes for hospital admissions or deaths, that you will see peaks and troughs, even apparent step changes, as causes and trends inadvertently 'gang up' in one direction or the other. There is no logical basis for the assumption of a common cause.
This is not to say that there aren't outbreaks of respiratory or other infections with novel viral aetiologies, but just looking at admissions and death rates in different places at different times is about as blunt a tool as you could possibly use. As others have suggested, you would start suspecting an 'outbreak' when there was a peak of patients with some defined clinical presentation. This is true for acute infections (Like MERS and Ebola) and also for the emergence of chronic conditions (eg. HIV/AIDS). As for outbreaks of some kind of immuno-modulatory virus that affects all cause mortality, I would say that is pure Hollywood.
It is a fantasy because you are asking two opposites of the virus/pathogen: On the one hand, you are asking it to be sufficiently non-pathogenic so that it doesn't create any overt/specific clinical symptoms, does not grow in culture or appear in sufficient numbers to be seen by electron microscopy, yet on the other hand, you are asking it to be able to infect large numbers of people, and cause pathology that contributes to their hospital admission or death.
Dear Jones, Only prevalence and death rate might not be so informative. Details insights into risk factors including serological of suspected or post mortem, and genomic analysis could be done correlated with clinical data. Clinical presentation, immunologic markers on healthy reservoir amongst the population should not be left out. I can be part !
HI Matthew,
You need to read the more detailed research at www.hcaf.biz in the Emergency admissions web page.
Cheers
Rod
We are interested to investigate the outbreak. Please let us know a little bit about it such as age, sex, area distribution, symptoms, signs, type of epidemic, probable ways or transmission & possible cause of death etc.
Dear Rodeny,
You are right all these undiscovered new diseases should be investigated well.Am happy to share what I have and will contact you soon.
Best!!
Ephrem
Hi Rodney,
It sounds interesting. I have requested a draft like Partha, to the email you provided.
When CHIKV first broke out in the US Virgin Islands and the CDC didn't even know the vector yet, just that there was a dengue like disease. It has traveled fast and we don't know that much about it, since research funds are much slower and more difficult to get that the disease to be studied. The day I was leaving for a field study in Panama in April, I got an Alert on my phone of 16 new confirmed cases of CHIKV in Panama. The CDC doesn't consider it to be a fatal disease, but almost 50 deaths have occurred in Colombia. Rodney thanks for bringing this to the attention of the global health community! Terri
Hi Terri, I think this is possibly the first example of a new generation of more subtle diseases. The kinetics of spread are relatively slow and highly granular and this explains why these outbreaks have gone hidden for so long. Also this is not a 'silo' disease with a simple diagnosis, the effects are complex and can probably be best described as exacerbation of existing conditions. Hence it hides behind other recognisable diseases. Have just submitted a big review attempting to show that something like cytomegalovirus could cause such disease types. Still many questions to be answered which was why I asked for help. Cheers
Rod
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