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The public health infrastructure in the US is so antiquated that the Centre for Disease Control has likened it to a "pony express". The system still relies on paper-based reports and phone calls.
Despite years of warning about the possibility of bio-terrorism, when the first incident was reported on 4 October, only half the state, local and territorial health departments in the US had full-time Internet connectivity, according to a report on the public health infrastructure.
The Centre for Disease Control (CDC) used Atlanta county for a pilot project to enhance the capabilities of the nationwide Health Alert Network, a secure system intended to connect all public health departments with the CDC.
"We need to get into the modern age of communications," said Dr Paul Weisner, a board of health director in Georgia. "I can't track my emergency room patients in real time. Instead, I have an icon on my desk here that only gives me an update every 24 hours."
Dr Rex Archer, a health department director, said real-time information is needed to track not only emergency room visits, but also other indicators that could signal the spread of a natural or deliberate outbreak of disease.
The public health infrastructure lacks the funds to handle a major crisis, said Archer. The CDC has started to deploy a secure information system called the Epidemic Information Exchange (Epi-X), which uses digital certificates to ensure data privacy. However, deployment of the full-scale Epi-X system has been restricted to state level, leaving Archer with a read-only terminal. Archer said he needs the full-scale capability of Epi-X today.
Patricia Quinlisk, a state epidemiologist, has urged the US Congress to provide $50m (£35m) for a new CDC project called the National Electronic Surveillance System, designed to integrate as many as 100 separate data systems used by public health agencies. It would ensure the rapid analysis of data across data sets and regions, so that mandated reporters such as doctors would find reporting diseases significantly simplified.
However, CDC spokeswoman Barbara Govert, described the $90m (£63m) of government funding for the network as "minimal".
"Maybe the events of the past two weeks have made it easier to understand the importance of funding health care infrastructure," she said.