There have been a few great questions about operational definitions here in the HEAS for "suspected" versus "confirmed". Here is what we propose, and please do give input good / bad / ugly so that we may
standardize our terms between all of the relevant groups.
"Suspected". This is where we have received report of illness whose clinical presentation, either from the viewpoint of clinicians or lay people, is severe diarrheal disease. We recognize that this is likely
a multi-pathogen event, where other bacteria and viruses are co-circulating with cholera such as Shigella and typhoid. This of course confuses the picture to a degree.
"Confirmed". We have been using this term to denote laboratory confirmation. Now, the problem here is we often do not have direct confirmation provided by the laboratory itself such as LNSP or CDC,
particularly for rural or remote locations reporting suspect cases. If "confirmation" is reported second-hand, then there is some degree of uncertainty as to the veracity of the report.
Source credibility is an entirely different discussion. Some sources are highly credible but are quoting sources of questionable or unknown credibility. We have seen experientially sources of highest
credibility goofing a report due to human error. This is operational reality. We also have sources that are of highest credibility for, say, clinical medicine inside the United State but are commenting on
diseases they may have never seen in their careers in Haiti, which raises an immediate credibility question. So, credibility varies across sources, context, and topic.
We are trying our best to be as clear as possible, but situational awareness during crises is classically hallmarked by uncertainty. This is nearly universal whether we are talking about earthquakes,
storms, or epidemics. This is why we emphasize less of a focus on whether we have 2 or 5 suspect cases but be VERY focused on the local medical capacity status.
Lastly, it is far more time-consuming and difficult to provide credible laboratory diagnostic confirmation than it is to confirm that a clinic or hospital is overwhelmed. For laboratory confirmation, there are only only a handful of primary expert sources with this information... for medical capacity status, a far larger pool of lay people and journalists often provide excellent verification for us, which has tremendous operational value.
We hope this helps.
Cheers,
James M. Wilson V, MD
Haiti Epidemic Advisory System (HEAS)
Executive Director
Praecipio International
Washington-Houston-Port au Prince
jim.wilson@praecipiointernational.org
+1.571.225.3671
Praecipio International is a charitable non-profit organization
devoted to the promotion of operational biosurveillance worldwide.
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