NSW Government COVID-19 Updates Page Could be Sped Up.

The content on the NSW Government COVID-19 Updates page is well set out, but the page could be implemented better technically. It scores only 57/100 on the Google Page Speed Insights tests. could be sped up. Here are the changes Google suggests. Detailed advice is provided on the website for each:

• Reduce the impact of third-party code Third-party code blocked the main thread for 330 ms 
• Serve static assets with an efficient cache policy 9 resources found 
• Minimize main-thread work 2.4 s 
• Avoid chaining critical requests 24 chains found 
• Keep request counts low and transfer sizes small 48 requests • 548 KB

Video Conference on COVID-19 and the Rebewable Energy Business

Greetings from the Australian National University in Canberra, where I am taking part in a webinar (video conference) on "COVID-19 and the Household/Commercial Solar and Battery Storage Market", hosted by the Smart Energy Council. Interestingly there is a demand for batteries and solar in regional areas, perhaps due to a wish to be independent from the grid. However, demand is expected to reduce. The supply from China, the effects of the reduction in the value of the Australia dollar, and the government incentives were discussed. There was a reminder to look after staff health, and our own. This was an excellent example of how an industry association can keep their members informed. I suggest other industry bodies and professional societies follow this example.

There were only a few brief dropouts in the audio (fewer than on ABC Radio National this-morning). The talking heads video worked well and the presenters slides were very clear. One improvement would be to give a web link in the text chat with notes. As it was, the presenter suggested photographing the web address on a slide, which is cumbersome.

The video conferencing product being used was Zoom. This is not my favorite, as there is no way for participants to set the audio or video quality to reduce bandwidth. However, it is possible to reduce data use with a smaller video window.

During the presentation, with live video full screen, this was using about 1,000 kbps. If I reduced the size of the video window to 512 by 240 pixels, the data reduced to 300 kbps. Minimizing the video to a "thumbnail" (200 by 112 pixels) reduced data to 220 kbps. Hiding the video reduced data to 120 kbps. This is consistent with Zoom's documentation: 1.2 Mbps for HD video, screen sharing with  video thumbnail at 50-150kbps, and screen sharing only with no video thumbnail 50-75kbps.

During a presentation such as this, video is really only needed at the start to introduction the speaker, and at the end during questions, if at all. In between there are usually slides to look at, so the video can be minimized, or hidden. I suggest participant adopt that way of viewing, and if possible, event organizers set this up as the default.

Zoom, and other video products, adjust to the bandwidth available, but then tries to use all that bandwidth. This makes them poor online citizens, like someone who fills their trolley with toilet paper, if you let them.

As there is likely to be a high demand for Internet access over the next few months, I suggest that providers of video conference products set defaults to use less bandwidth. At the very least they could be set so only a small video window appears by default. Also they could provide a low speed option which uses no more than 256 kbps, and this could be made the default setting. As an example, Zoom has a maximum bandwidth setting, but this is disabled by default. This should be enabled and set to no more than 256 kbps.

NSW Health Coronavirus Web Page Slow and Unreliable Due to Flawed Design

NSW Health Coronavirus Page
(mobile version)

The NSW Health Coronavirus Page has been running slowly for some users, and failing completely for others with the error message: "Microsoft SharePoint Foundation cannot deserialize the Web Part. Check the format of the properties and try again". This page will be in high demand, and there are well established ways to code electronic documents for efficient delivery of emergency information.

A Google Page Speed check on the mobile version page rated it 18/100, which is a very poor result. The tool pointed out the page could be improved with some simple changes, such as using a more efficient format for images and changing the way style sheets (CSS) are used.

In 2005 I supervised a student project at ANU on how to design credible emergency websites. From this a set of Emergency Management Website Assessment Criteria was produced. There is also a detailed report.

If you are providing emergency information online, please make your web pages small, simple, and clear.=

How Tech Can Help with the COVID19 Pandemic

The most useful things we can do to help with the COVID19 pandemic are not very high tech, or glamorous. The things which are high tech take years to design and implement, so I suggest helping implement those which have already been developed, and not building new ones. This advice is based on twenty years helping out with tech for emergencies.

Some things we can do:

USE THE INTERNET TO PROVIDE INFORMATION AND COUNTER MISINFORMATION

We can help educate the community on what to do, and counter misinformation.

In 2005 I supervised a student project at ANU on how to design credible emergency websites. From this a set of Emergency Management Website Assessment Criteria was produced. There is also a detailed report.

SUPPORT EXISTING TOOLS

Also we can assist with tools, services, and support, to help people work, study, and be entertained on-line. Networks and servers may be more heavily loaded than usual. We can implement ways to reduce the load, by configuring systems to use less data and processing, and giving users tips on using them efficiently. As an example, the bandwidth used by video conferencing can be reduced by avoiding using high resolution video (or by avoiding the use of video at all). Web pages can have images with reduced resolution, and optimized code.

SUPPORT EXISTING SPECIALIZED EMERGENCY TOOLS

There are more specialized tech tools for supporting large scale emergencies, such as the Sahana Open Source Disaster Management Software. In 2013 I talked at a Meetup in Colombo to discuss using Sahana for mapping a pandemic.

Sahana was developed by the Sri Lanka tech industry in response to the 2004 Indian Ocean tsunami. The software was then used around the world for other emergencies. But it takes time to have such software accepted. One thing done with Sahana was to set up a US registered foundation, not only to get funding, but more importantly, credibility.

Combating Coronavirus with Free Software

In "Coronavirus – the next pandemic?" (Online Opinion, 15 May 2013) Peter Curson points out that national boundaries offer no defense from new diseases:.

One answer is better tracking of the disease near the source. A few weeks ago I was in Colombo and was asked by local ICT professionals to talk about how computers could be used to combat a pandemic.

Doctors researching infection came along and we work-shopped what could be done. One idea was to use mobile phones to allow doctors to quickly report cases, which could then be mapped in near real time. Currently, in most countries, cases of reportable diseases are communicated on paper, which could days, or weeks, to get from an outlying clinic to the national department of health, by which time the disease could have spread widely.

Members of the Sahana Software Foundation, who work on free open source humanitarian software, are now looking at how to produce such a tool.

Mobiles and e-learning for Pandemic Flu Response

Tom Worthington will be speaking on "Mobiles and e-learning for Pandemic Flu Response" to members of the Sahana Software Foundation, 5:30pm to 6:30pm, Tuesday, 7 May 2013 at the Virtusa Auditorium  (Orion City), 752 Dr Danister De Silva Mawatha, Colombo 09, Sri Lanka. See also:

• E-government for emergencies: dealing with a bird flu pandemic using the wireless web and podcasting
• MOOCs with Books

Making Pandemic Influenza Plans Visible

The report "Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments", indicates that most Australian hospitals had a plan to deal with such an emergency, the plans were activated and were useful. But 43% of hospital staff in did not know the plans existed or were in force. There were also inconsistencies found in plans between different parts of the health system, both between GPs and hospitals and also different specialists in the hospitals. The report emphasised the importance of community and public health involvement and communication strategies. One obvious tool to use is the web. Plans for such health emergencies should be published online. The documents should be in an easy to read format which doctors (and others) can read on their smart phones. Online consultation tools can be used to get wide input. This might provide a useful case study for COMP7420: Electronic Data Management.

On 25 April 2009, the World Health Organization (WHO) determined that
member states and partners should increase their surveillance programs and
prepare for an epidemic14. Australia activated its pandemic plan, The Australian Health Management Plan for Pandemic Influenza 2008 (AHMPPI 2008)19, in line with this recommendation15. ...

There is contradictory information in pandemic plans devised for different sections of the health care system. For example a 2003 survey, undertaken on behalf of the Australian and New Zealand Intensive Care Society, identified hospital EDs as additional short-term bed spaces for ventilated patients in the event of a pandemic8. This ignores the issue that, during a pandemic, EDs have increased demand on their space and resources and cannot be expected to also function as satellite ICUs. ...

Pandemic plans

About two out of five (39%) of respondents reported that they knew that their hospital or ED had a written pandemic plan before the onset of the (H1N1) 2009 influenza pandemic as shown in Table A-8. In most cases, these plans were part of a hospital plan, but 50 respondents did report working in an ED with a stand-alone ED pandemic plan. Notably, a large proportion (43%) of respondents did not know whether a plan existed for their department or hospital. These responses differed strongly by discipline, with more than three-fifths of registrars (62%) falling into the ‘don’t know’ category, compared to only 33% of SMOs, and 34% of nurses.

Of those reporting the existence of a pandemic plan, two-thirds (66%) knew that it had been activated during the (H1N1) 2009 influenza pandemic, and 19% knew it had not been activated. The remaining 15% did not know the status of the pandemic plan activation in their department. Of those reporting an activated plan, the overwhelming majority (98%) stated that it had been at least somewhat useful in dealing with Pandemic (H1N1) 2009 Influenza. The overall mean score was 3.6 on the 5-point scale ranging from ‘not at all useful’ to ‘very useful.’ Again, registrars were more likely to report not knowing whether the pandemic plan had been activated. ...

Pandemic plans

The parts of pandemic plans found useful by respondents included the policies, procedures, and protocols, which had been set up in advance of the pandemic. These included guidelines for triage, isolation, cohorting, proper use of PPE, and other infection control measures. Arrangements for obtaining extra staffing and more PPE were also welcomed, as was the provision of separate triage and flu clinics.

Limitations to pandemic plans included a lack of specificity to individual hospitals, Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments. 38 with some hospital designs making them difficult or impossible to implement, particularly with respect to the isolation of potentially infectious patients and appropriate patient flow from triage, through the department, and home or to wards. Many respondents stated that the plans were designed for a far more virulent disease. Plans also did not take pre-existing heavy workloads into account.

Suggestions for the future included greater involvement in planning of major stakeholders including EDs, GPs, public health, infection control, and pathology clinicians, as well as members of the community. Participants recommended implementing procedures to divert patients who could more properly be seen by GPs and establishing flu clinics out of EDs. Better stockpiling and release of PPE and antivirals was also mentioned, together with separate flu clinics close to EDs, with some designated flu hospitals. Respondents felt there should be more preparation and practice of any future plans. They also raised issues about creating surge capacity within hospitals, particularly by addressing the pre-existing problem of access block, and the necessity of special pandemic funding in the event of a pandemic. ...

Pandemic and disaster plans

All but one of the directors reported that a pandemic plan was in place for their department before Pandemic (H1N1) 2009 Influenza, as shown in Table B-3. Of the 11 plans, 10 were part of a general hospital plan and one was a stand-alone ED plan. In seven out of ten cases, the pandemic plan was activated during the (H1N1) 2009 influenza pandemic, and amongst these responses, most directors found the plan useful. In responding to open-ended questions about what was specifically useful, or not useful, about the activated pandemic plan, directors referred to clear guidelines (e.g. for triage), lines of responsibility, setting up a ‘fever clinic’, and the involvement of other areas of the hospital, as being useful. Several of those mentioning the ‘not useful’ aspects of their pandemic plan also referred to other members of their hospital’s staff, saying, for instance, that they had not shared the load. Also mentioned as problematic was the lack of staff management strategies, and that
staff had not been pre-fitted for respirators.

Directors were given the opportunity to make suggestions for developing ED-related pandemic plans for managing future pandemics. Directors of Emergency Medicine recommended that flu clinics be established early, so that EDs are not required to deal with the full volume of patients. They pointed to the critical importance of community and public health involvement from the beginning. Improvement in communication strategies was also mentioned, as was better provision of isolation facilities within EDs and better staff management strategies (filling in, redeployment,
etc.).

Directors were also asked whether their hospital’s formal disaster plan had been activated during the (H1N1) 2009 influenza pandemic. No disasters plans were activated. ...

Of significance was the relationship between the pandemic planning approach and disaster planning. A small proportion of staff reported the activation of their organisation’s disaster plan. Some individuals felt activating disaster plans would have delivered a higher level of support. The relationship between pandemic and disaster planning needs to be clarified. ...

From: "Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments". FitzGerald, Gerard and Patrick, Jennifer R and Fielding, Elaine L and Shaban, Ramon Z. and Arbon , Paul and Aitken, Peter and Considine, Julie and Clark, Michele J. and Finucane, Julie and McCarthy, Sally M and Cloughessy, Liz and Holzhauser, Kerri (2010), QUT, Brisbane QLD Australia.

Dealing with a pandemic in an educational institution

An international conference was run from Hong Kong in 2003 on how to deal with the SARS outbreak in university and other educational institutions ("Educational Narratives and Reflections in the time of SARS"). The papers from the conference are available online and would be of value for schools, vocational institutions and universities now considering how to deal with a flu pandemic. Assuming institutions will simply shut down is a dangerous assumption to make.

Paper Title	Description	Sent in by	Date
VITLE classes: HKBU library supporting e-learning during SARS outbreak	On how the VITLE system at HK Baptist University was used to deliver general courses to schools and the public and on a library-run course on searching. (Ref: 76)	SOUL System Admin	30-MAY-2003 10:15:29
IT Learning meeting notes of 16 April 2003	Notes of a meeting of a small group of senior staff commenting on how HKU coped with teaching during SARS. (Ref: 74)	SOUL System Admin	30-MAY-2003 10:12:56
Does your library disaster preparedness plan have a section on epidemics?	A revised draft written for a library magazine (Ref: 73)	SOUL System Admin	30-MAY-2003 10:11:48
"Mind the Gap"	A school principal's frustrations. How have others felt? (Ref: 72)	McNaught, Carmel	26-MAY-2003 13:27:47

From: Educational Nattitives and Reflections in the time of SARS, Hong Kong Web Symposium Consortium, 19-31 May 2003.

Influenza Pandemic Business Continuity Guide

The Australian Government released a Influenza Pandemic Business Continuity Guide for Australian Businesses in July 2006. This is available as a 340 KByte, 68 page PDF file. Unfortunately the document is not available as an easy to read and download web pages. It suggests use the telephone, video conferencing and the internet to conduct business as as a way to avoid meeting people face to face, even when participants are in the same building. However, it points out that demand for services may be impacted by a pandemic, for example demand for internet access may increase. It suggests checking the business has an adequate infrastructure, including computer networks and internet presence.

Unfortunately the guide does not explicitly mention teleworking as a strategy, even though the same government department which produced the guide also funds Telework Australia to promote online working.

Also available is an Influenza Pandemic Kit for Small Businesses withm materials both as web pages and downloadable in PDF:

1. Booklet: Being prepared for an influenza pandemic:
   1. Help Protect Your Staff And Customers From Getting Sick
   2. Plan Now To Keep Your Business In Business
   3. Ten Steps You Can Take To Be Better Prepared For A Pandemic
   4. What Is A Human Influenza Pandemic?
   5. Where Can I Find More Information?
2. Reference sheets
1. Pandemic Phases
2. Workplace Cleaning Products
3. What if employees become ill at work during a pandemic?
4. Pandemic planning checklist for small businesses
3. Health posters:
1. COUGH ETIQUETTE AND RESPIRATORY HYGIENE
2. HOW TO CLEAN HANDS USING AN ALCOHOL-BASED LIQUID OR HAND RUB
3. HOW TO FIT AND REMOVE A P2 RESPIRATOR
4. HOW TO FIT AND REMOVE A PROTECTIVE GOWN
5. HOW TO FIT AND REMOVE A SURGICAL MASK
6. HOW TO FIT AND REMOVE PERSONAL PROTECTIVE EQUIPMENT IN THE CORRECT ORDER
   
7. HOW TO FIT AND REMOVE PROTECTIVE EYEWEAR
8. HOW TO FIT AND REMOVE PROTECTIVE GLOVES
9. HOW TO WASH AND DRY HANDS
10. STAFF INFLUENZA NOTICE
11. TRAVEL HEALTH

Table of Contents
1. Introduction and purpose of this guide 1
2. What is avian influenza and pandemic influenza? 3
H5N1 (avian influenza or bird flu) 4
Human Influenza 5
Prevention and Treatment 6
3. What is the Government doing? 9
Government Support 10
Australian Health Management Plan 10
Containment 12
Maintaining society’s functions 13
National Action Plan for Human Influenza Pandemic 13
State and territory government activities 13
4. How might pandemic influenza affect my business? 15
Characteristics of a pandemic 16
Staff absenteeism 16
Other immediate effects 17
Financial implications 17
5. How can I minimise the impact of a pandemic on my business? 21
Preparation 22
Business continuity planning 23
Step 1: Identify your business’ core people and skills 23
Step 2: Establish a pandemic planning team 23
Step 3: Plan for staff absences 24
Step 4: Consider the effects of supply shortages on operations 25
Step 5: Establish and maintain two-way communication 25
Step 6: Consider human resource issues 26
Step 7: Test your plan and know when to activate it 29
6. How can we help protect staff from getting sick? 31
Basic precautions 32
Practice good personal hygiene 32
Workplace cleaning 33
Air conditioning 34
Personal protective equipment 35
Social distancing—reducing contact with others 35
Restricting staff travel 36
Restricting workplace entry 37
Annual influenza injections 37
Screening workers and managing staff who become ill at work 37
iv
7. How do I manage my customers and stakeholders? 39
Communication 40
Duty of care to your customers 40
8. What other tools are available? (Appendices A–D) 41
Online Resources 42
Hotline 42
A. Pandemic planning checklist 43
B. Planning scenarios 50
C. Background on previous pandemics 54
D. Frequently Asked Questions 56
Health information posters are located inside the back pocket of this guide

From: Influenza Pandemic Business Continuity Guide for Australian Businesses, Department of Innovation, Industry, Science and Research, July 2006

Maintaining services online during a flu pandemic

The Australian National University has released a revised ANU Pandemic Response Plan. Like many such plans, this envisages a progressive reduction of organisation activities with all but essential activities being stopped. However, this is based on the assumption that educational activities require gatherings of people. Instead, education and many administrative services, can be maintained using telecommunications, while avoiding face-to-face gatherings of people. Most staff and students can stay at home, but maintain many educational and research activities online.

Some simple steps would be required, such as checking that procedures allow for distribution of electronic documents in place of paper ones. Some procedures for example may refer to requiring "signatures". This requirement can usually be met with an email message with the person's name typed on it, but where a higher level of authentication is required, submission via a password protected system might be needed . Staff may need to be issued with additional equipment at home and trained in its use. Students may need advice on what to get. Online courses would need to be checked to make sure they work on slower home links and ones overseas. Servers would need to be checked for capacity.

In addition to telephone and Internet services, educators can make use of broadcast and cable TV services, including in Canberra Transact, to provide content. In the event of a pandemic, is likely that a significant proportion of the Canberra population will be at home and looking for something to keep them stimulated. The universities and schools might make some materials available for this purpose.

ps: The ANU COMP2410 students have completed their assignment on designing a swine flu advice web site for Australia. This expertise is now available, if needed.

Designing an influenza pandemic web site for Australia

Students of "Networked Information Systems" (COMP2410/6340) at the ANU have been set the task to design a influenza pandemic web site for the Australian public. In previous years they have been set the task to design a site for bird flu so this seemed a logical and timely topic.

Australian National University

Department of Computer Science

Networked Information Systems

COMP2410/6340

Assignment 2

Website Accessibility

Introduction

On 29 April 2009 the Director-General of the World Health Organization (WHO), raised the level of influenza pandemic alert from phase 4 to phase 5. All countries were advised to immediately activate their pandemic preparedness plans to combat Swine influenza.

In this assignment you will examine web sites used for providing advice to the public about influenza and design a prototype web site using the techniques learnt in the course. ...

Deadline: 6pm Friday 22 May 2008.

The Task

The Australian Government Department of Health and Ageing (DHA) has provided a web page with links to detailed information about Swine Influenza Outbreaks. However, that information may be difficult to understand for the average member of the general public. Imagine you work for the Australian Government and your task is to design an easier to read web site based on the DHA page as it was at 30 Apr 2009 07:09:19 GMT.

The web site will need to meet accessibility and mobile device standards. The web site will be read by large numbers of people at once and so will need to use the minimum of bandwidth. It will be read by people under stress and so be easy to read.

In addition to the information in the copy of the DHA web site, you can use text and media files (images, audio and video) from International (.int), Australian Government (.gov.au) and US Government (.gov) web sites in designing your prototype.

Creating the webpage

You must:

• Convert the HTML of the content from the existing web page to valid XHTML Basic 1.1 which achieves at least 80/100 on Mobile OK tests and passes Level Double A of the W3C - Web Content Accessibility Guidelines 1.0 (WCAG 1.0) as tested by the TAW (Web Accessibility Test)
• Convert all presentation elements and in-line styles to appropriate rules in a new valid external style sheet called access.css
• Remove any tables in the webpages which are not used for displaying tabular data, and replace them with CSS rules
• Remove or replace excessively large or irrelevant images. You are encouraged to consider the use of Pictograms, as well as links to audio, video and other multimedia content.
  
• Make any changes to the XHTML code which you consider to either: enhance the accessibility of the page, or improve the compliance of the page with web standards
• Discuss your design decisions in a report
• Estimate the download time of your page (using the access.css stylesheet) using a 28.8 kbit/s Iridium satellite modem (as used by the Australian Department of Defence). Suggest ways in which you might reduce the download time. These question must be answered in the form of an additional section in your report.

Your resulting page need not be identical in appearance to the web pages the source material was prepared from. You need only create the home page, but can create dummy links to other pages (which you need not create). The emphasis should be on a simple and efficient design. The page should be designed to display both on a smart phone and a desktop computer. Design decisions about the way the page looks must be discussed in your report.

Writing the report

You are also required to write a report which presents and justifies your design decisions. The report should be between 600-1000 words long (the word length is not assessable, but a report which falls outside these limits may impact on your ability to complete all assessable tasks). The report should include (but is not restricted to) discussions of the following topics:

• Any design decisions you made which significantly alter the appearance of the webpage. These must be justified by an appeal to accessibility, web standards, or best practice coding guidelines.
• Changes you have made to the code which you consider to have enhanced the accessibility of the webpage.
• Alternative design decisions which you considered implementing, along with a discussion of the advantages and disadvantages of these.
• Any accessibility issues, or areas of non-compliance with web standards, which are still present in your completed page.

Your report must be valid XHTML-Basic 1.1. The formatting must be clear, and include headers and paragraphs. Citations are not needed. ...

Resources

For examples of government swine flu web sites, see Tom Worthington's posting: Lack of useful Swine Influenza Information online from Australian Government, Thursday, April 30, 2009. ...

Lack of useful Swine Influenza Information online from Australian Government

Senator Lundy posted an item to her new web site on 29 April, pointing out that the Department of Health and Ageing (DHA) established a website to provide information on Swine Influenza. That got me thinking about what information was available for the public. I was unable to find any clear and coordinated information for the public from Australian Governments. Instead there are an assortment of web reference to detailed information to officials and cross references which will lead the reader around in circles.

The DHA appears to be for medical practitioners, not the general public. It refers people to DHA's "Health Emergency" web page. This has a paragraph about swine flu and then a link to "Swine Influenza Outbreaks", which contains the equivalent of five pages of text and then links to detailed documents about the number of cases reported so far. All this material appears to be intended for officials, not the public:

National tally of people being tested for Swine Influenza as at 6 am,
30th April 2009

Australia
AUS Phase DELAY

Table 1: Current Australian Cases Under Investigation
0600 AEST 30/04/2009

Jurisdictions	Suspect Cases	Probable	Confirmed
ACT	1	0	0
NSW	51	0	0
Vic	24	0	0
Tas	1	0	0
Qld	27	0	0
SA	11	0	0
NT	1	0	0
WA	12	0	0
Total	128	0	0

Source: CDNA

From: Swine Influenza Update Bulletin,Department of Health and Ageing, 6am, 30 April 2009

The World Health Organization (WHO) has a Swine influenza - Epidemic and Pandemic Alert and Response (EPR) but this is intended for national public health officials. The Australian Capital Territory Department of Health has a Swine Influenza page, but this refers to the DHA and WHO pages.

healthdirect Australia, a joint initiative of the Australian, ACT, NSW, NT, Tasmania, SA and WA governments has a "health alert" on its home page, but this just links to DHA.

The Centers for Disease Control and Prevention (CDC)has videos on YouTube, showing the correct way to wear a face mask.

Dealing with Swine Flu pandemic using smart phones and podcasting

Australian government agencies are advising of Swine Flu Precautions. In 2006 I presented "E-government for emergencies: dealing with a bird flu pandemic using the wireless web and podcasting" at CeBIT Australia (extended technical presentation, ANU, 26 March 2007). This discussed how wireless web technology and podcasting could be used for dealing with a possible influenza pandemic. This included providing advice to the public and to officials on what to do, using the technology to manage health resources. Students in the ANU course "Networked Information Systems" COMP2410 learnt how to design web pages for this and many of them now work in and for government agencies.

One problem at the time was, and remains, that there is no unified web based service in Australia. Each state health authority issues its own information in its own format. While this made sense when the information was issued in the form of brochures the public might pick up at their local library it makes little sense online, where the state governments are just as accessible as each other.

The Internet can also be used to keep services operating, including government, with fewer staff and where gathering of people is not possible.

Google Detecting influenza epidemics

Staff of Google in collaboration with the Centers for Disease Control and Prevention, have published a letter in Letter in the prestigious scientific journal Nature on "Detecting influenza epidemics using search engine query data". The idea is that people with the flu will do web searches about it, thus alerting authorities to an outbreak. This is a cleaver idea, but not the one I had in mind when I proposed using the web for an combating avian influenza epidemic.

Seasonal influenza epidemics are a major public health concern, causing tens of millions of respiratory illnesses and 250,000 to 500,000 deaths worldwide each year¹. In addition to seasonal influenza, a new strain of influenza virus against which no previous immunity exists and that demonstrates human-to-human transmission could result in a pandemic with millions of fatalities². Early detection of disease activity, when followed by a rapid response, can reduce the impact of both seasonal and pandemic influenza^{3, 4}. One way to improve early detection is to monitor health-seeking behaviour in the form of queries to online search engines, which are submitted by millions of users around the world each day. Here we present a method of analysing large numbers of Google search queries to track influenza-like illness in a population. Because the relative frequency of certain queries is highly correlated with the percentage of physician visits in which a patient presents with influenza-like symptoms, we can accurately estimate the current level of weekly influenza activity in each region of the United States, with a reporting lag of about one day. This approach may make it possible to use search queries to detect influenza epidemics in areas with a large population of web search users. ...

From: Detecting influenza epidemics using search engine query data, Jeremy Ginsberg, Matthew H. Mohebbi, Rajan S. Patel, Lynnette Brammer, Mark S. Smolinski & Larry Brilliant, Nature , doi:10.1038/nature07634; Received 14 August 2008; Accepted 13 November 2008; Published online 19 November 2008

Detect Influenza outbreaks with web searches

Google have created a service to "Explore flu trends across the U.S.". The system tracks the use of search terms which indicate that people have influenza and plots this on a graph over time and a map of the USA. According to "Google Uses Searches to Track Flu’s Spread" (By MIGUEL HELFT, The New York Times, November 11, 200), a paper on this will be published in Nature.The idea of using web searches to detect natural phenomena is not a new one, with previous proposals to use internet traffic to detect earthquakes. The technique might be used as part of an ICT system to deal with an Avian Influenza Pandemic.

Each week, millions of users around the world search for online health information. As you might expect, there are more flu-related searches during flu season, more allergy-related searches during allergy season, and more sunburn-related searches during the summer. You can explore all of these phenomena using Google Trends. But can search query trends provide an accurate, reliable model of real-world phenomena?

We have found a close relationship between how many people search for flu-related topics and how many people actually have flu symptoms. Of course, not every person who searches for "flu" is actually sick, but a pattern emerges when all the flu-related search queries from each state and region are added together. We compared our query counts with data from a surveillance system managed by the U.S. Centers for Disease Control and Prevention (CDC) and discovered that some search queries tend to be popular exactly when flu season is happening. By counting how often we see these search queries, we can estimate how much flu is circulating in various regions of the United States. ...

From: How does this work?, Google Flu Trends, Google, 2008

Notifiable Avian Influenza Surveillance

The New Zealand government has issued a request for tender for "Notifiable Avian Influenza Surveillance". The results will be entered in the IRS database (Sahana is also expanding its open source software to record such diseases in humans):

i. Defining New Zealand’s status for notifiable avian influenza viruses of concern (manage biosecurity risks);

ii. Defining baseline information about potentially zoonotic avian influenza viruses (protect human health);

iii. Fulfilling international certification requirements for trade in birds and avian products (protect trade).

From: Notifiable Avian Influenza Surveillance, Ministry of Agriculture and Forestry, GETS Reference: 21468, 2008

Australian Influenza Symposium

Was wondering where the proceedings of the Australian Influenza Symposia were published. I was having lunch in the cafe at the John Curtin School of Medical Research. The 3rd Australian Influenza Symposium is underway there (4 to 5 October 2007). This is sponsored by the Office of Health Protection, Department of Health and Aging, Australian Government; Australian WHO Collaborating Centre for Reference and Research on Influenza; and the Therapeutic Goods Administration.

Some of the topics, such as "Confronting the Next Pandemic", several on H5N1 (avian influenza or "bird flu") and also Equine Influenza ("Horse Flu") sounded interesting, as I have talked on "Dealing with a bird flu pandemic using the wireless web and podcasting". But when I did a web search I found no references to the 2007 symposium and only two references to the 2006 symposium. Perhaps medical people don't call for papers or publish results online?

ps: Also there was a business card "Wanted Epidemic Reporters" from NSW Health, with the web address "flutracking.net". This appears to be a online system for detecting a flu outbreak:

Welcome to the Epidemic Reporter Influenza Tracking Project Web Site

We are looking for people who live in Australia and are 18 years of age or over and have easy access to email and the internet on a weekly basis.

A new health surveillance system to detect epidemics of influenza is being trialed which will require people willing to spend about 10 - 15 seconds per week to respond to an email about symptoms they may have had in the previous week. This trial will help us find ways to detect both seasonal influenza and hopefully pandemic influenza and other diseases so we can better protect the community from epidemics.

Participation is voluntary and your information will be kept confidential. As a participant, you will receive weekly information on influenza-like activity in the region based on our analysis of the data. ...

From: Epidemic Reporter Project, Hunter New England Area Health Service, NSW Health

Some books:

• Influenza Pandemic
• Avian influenza
• Equine Influenza

Influenza Pandemic Exercise Report Available

A 72 page report on the 2006 Australian National Pandemic Influenza Exercise is available online from the federal government. Anyone interested in how to deal with a pandemic, or with how to conduct an exercise for a major disaster should read it.

"Exercise Cumpston 06: National Pandemic Influenza Exercise Report", Department of Health and Ageing, Office of Health Protection, , Australian Government, 2007 is available as a 493 kbyte PDF document. A HTML version is promised on the web site.

Below I have picked out some of the report's findings and recommendations related to ICT, Internet and the Web. In 2005 and I talked at a conference in 2006 using the wireless web and podcasting in a pandemic. Some of those techniques might be used to address problems found in the exercise.

Use open source systems for pandemic?

It appears that Australian agencies have built their own web based systems:

• Health Alert Network (HAN)
• NetEpi web based outbreak reporting and management system, and
• An unnamed exercise management system.

Problems were experienced with all of these during the excise. Such systems will rarely be used by most of their intended users and will only rarely be exercised. There development and operation are expensive and problematic. In addition these systems will be of little value if other countries have no such systems and thus have unmanaged outbreaks of influenza.

It may make better use of resources if DoHA was to release these systems as open source software and make them available for global use, particularly by developing nations. The Sahana Disaster Management System provides an award winning example of this approach. An Australian Government example of open source development is the National Archives of Australia's Xena electronic archiving software.

As well as pooling expertise and making a system available for third world nations, building an open source system would have advantages for design. This would place a discipline on developers that the system would have to be very simple to use, efficient, easy to understand and very compliant with widely used standards.

Excepts from 2006 Australian National Pandemic Influenza Exercise Report

Recommendation 3: Health electronic communications systems, including the Health Alert Network and the Department of Health and Ageing website, need to be further developed and exercised.

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5.2.4 Information and communications technology

A number of information and communications technology (ICT) systems were utilised for information collection and dissemination, including a new secure information sharing network currently under development by DoHA, the Health Alert Network (HAN). This system encountered 'bedding-down' problems, and was new to many users. Lack of familiarity caused a degree of distrust in the system, and to compensate, duplicate systems were used (for example, the same message sent out on normal e-mail and HAN). As a result there was considerable overlap and information overload.

While many users were comfortable with HAN, others complained that the system was not intuitive, that it was cumbersome to use, and that response times were slow. It was apparent that user expectations were not being met, and that training and familiarisation was inadequate. Specific problems encountered with HAN included:

• unacceptable delays incurred in the distribution of alerts;
• alerts not indicating the priority of the content; and
• the system not allowing multiple addressing.

A secure system is always going to be more difficult to access and use than an unclassified one. It may be necessary to consider a more limited range of uses for HAN or improve its functionality so that it can complement other systems, particularly e-mail.

Rationalisation of information systems and methods is necessary, as is appropriate training to ensure familiarity with their use. HAN is part of the Biosecurity Surveillance System being developed by DoHA, which is further discussed in Section 5.4.3.

The main activity also identified ICT issues relating to the DoHA exercise website that hindered rapid communication among participants. The password-protected website designed for exercise play performed poorly. There were delays, caused by technical problems, of up to several hours in posting materials onto the website, which led to information vacuums at critical points of the response. This caused confusion among participants and pseudo media throughout the main activity.

The main activity reinforced DoHA's need to re-examine the robustness of its IT systems in handling the large volumes of visitors to its website that could be expected during a pandemic. DoHA also needs to examine its website capacity for the downloading of vision and sound files that would be critical in ensuring the media is well served.

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Information was available for the public and health care workers online, but its existence and how to access it were not well promoted to the public via the pseudo media. Rural and remote communities may have limited access to the Internet and this medium should not be relied upon as the sole means of disseminating public information. There was no information available targeted to Indigenous and culturally and linguistically diverse (CALD) populations.

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5.4.3 ICT infrastructure for surveillance

State and territory health departments collected information on cases and their contacts using nationally agreed definitions developed by the CDNA. This information was entered into a single point: a web based outbreak reporting and management system called NetEpi.

While the version of NetEpi maintained by DoHA is an interim system only (with recognised limitations), there were nevertheless criticisms and a lack of national consistency in its use, particularly in relation to data entry and the format of data fields. It should be noted that the version of NetEpi used was not the most current version and subsequent versions have addressed a number of the ICT limitations identified in the main activity. It is essential that there is national agreement in regard to data collection for any web based ICT system to be used effectively for national data collection.

In addition to the use of NetEpi, jurisdictions were encouraged to update the NIR via telephone in regard to critical events, for example, confirmation of cases or deaths. While NetEpi was generally updated within several hours, at some stages there were inevitable discrepancies between current jurisdictional reports at teleconferences, and the NIR reports, which were also delayed at times by clearance processes. In a rapidly changing environment these discrepancies are unavoidable. Criticism of this could be tempered by agreed regular reporting timeframe, so that national data are current up to a determined point, with acknowledgement that individual jurisdictions may hold more up-to-date information.

DoHA is currently improving the infrastructure of national communicable disease surveillance systems. The Biosecurity Surveillance System (BSS) is being developed to provide a more effective and comprehensive surveillance system. Components include enhancement of both HAN (Section 5.2.4 refers) and NetEpi. The lessons learned during Cumpston 06 should be applied in the BSS development.

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Recommendation 10: General practitioners, community pharmacies and other primary care providers need to be better integrated into detailed plans at national and jurisdictional level. To achieve this: (a) the role of general practitioners, pharmacists and other primary care providers needs to be clarified in preparedness plans following consultation with providers; and (b) the primary care annex of the Australian Health Management Plan for Pandemic Influenza should be published on the Department of Health and Ageing web as a priority.

The "Australian Health Management Plan for Pandemic Influenza" is at: