A cluster of people talking on social media about their mysterious rashes. A sudden die-off of birds at a nature preserve. A big bump in patients showing up to a city’s hospital emergency rooms.

These are the kinds of events that public health officials are constantly on the lookout for as they watch for new disease threats.

Health emergencies can range from widespread infectious disease outbreaks to natural disasters and even acts of terrorism. The scope, timing or unexpected nature of these events can overwhelm routine health care capacities.

I am a public health expert with a background in strengthening health systems, infectious disease surveillance and pandemic preparedness.

Rather than winging it when an unusual health event crops up, health officials take a systematic approach. There are structures in place to collect and analyze data to guide their response. Public health surveillance is foundational for figuring out what’s going on and hopefully squashing any outbreak before it spirals out of control.

Tracking day by day

Indicator-based surveillance is the routine, systematic collection of specific health data from established reporting systems. It monitors trends over time; the goal is to detect anomalies or patterns that may signal a widespread or emerging public health threat.

Hospitals are legally required to report data on admissions and positive test results for specific diseases, such as measles or polio, to local health departments. The local health officials then compile the pertinent data and share it with state or national public health agencies, such as the U.S. Centers for Disease Control and Prevention.

When doctors diagnose a positive case of influenza, for example, they report it through the National Respiratory and Enteric Virus Surveillance System, which tracks respiratory and gastrointestinal illnesses. A rise in the number of cases could be a warning sign of a new outbreak. Likewise, the National Syndromic Surveillance Program collects anonymized data from emergency departments about patients who report symptoms such as fever, cough or respiratory distress.

Public health officials keep an eye on wastewater as well. A variety of pathogens shed by infected people, who may be asymptomatic, can be identified in sewage. The CDC created the National Wastewater Surveillance System to help track the virus that causes COVID-19. Since the pandemic, it’s expanded in some areas to monitor additional pathogens, including influenza, respiratory syncytial virus (RSV) and norovirus. Wastewater surveillance adds another layer of data, allowing health officials to catch potential outbreaks in the community, even when many infected individuals show no symptoms and may not seek medical care.

Having these surveillance systems in place allows health experts to detect early signs of possible outbreaks and gives them time to plan and respond effectively.

Watching for anything outside the norm

Event-based surveillance watches in real time for anything that could indicate the start of an outbreak.

This can look like health officials tracking rumors, news articles or social media mentions of unusual illnesses or sudden deaths. Or it can be emergency room reports of unusual spikes in numbers of patients showing up with specific symptoms.

Local health care workers, community leaders and the public all support this kind of public health surveillance when they report unexpected health events through hotlines and online forms or just call, text or email their public health department. Local health workers can assess the information and escalate it to state or national authorities.

Public health officials have their ears to the ground in these various ways simultaneously. When they suspect the start of an outbreak, a number of teams spring into action, deploying different, coordinated responses.

Collecting samples for more analysis

Once event-based surveillance has picked up an unusual report or a sudden pattern of illness, health officials try to gather medical samples to get more information about what might be going on. They may focus on people, animals or specific locations, depending on the suspected source. For example, during an avian flu outbreak, officials take swabs from birds, both live and dead, and blood samples from people who have been exposed.

Health workers collect material ranging from nose or throat swabs, fecal, blood or tissue samples, and water and soil samples. Back in specialized laboratories, technicians analyze the samples, trying to identify a specific pathogen, determine whether it is contagious and evaluate how it might spread. Ultimately, scientists are trying to figure out the potential impact on public health.

Finding people who may have been exposed

Once an outbreak is detected, the priority quickly shifts to containment to prevent further spread. Public health officials turn into detectives, working to identify people who may have had direct contact with a known infected person. This process is called contact tracing.

Often, contact tracers work backward from a positive laboratory confirmation of the index case – that is, the first person known to be infected with a particular pathogen. Based on interviews with the patient and visiting places they had been, the local health department will reach out to people who may have been exposed. Health workers can then provide guidance about how to monitor potential symptoms, arrange testing or advise about isolating for a set amount of time to prevent further spread.

Contact tracing played a pivotal role during the early days of the COVID-19 pandemic, helping health departments monitor possible cases and take immediate action to protect public health. By focusing on people who had been in close contact with a confirmed case, public health agencies could break the chain of transmission and direct critical resources to those who were affected.

Though contact tracing is labor- and resource-intensive, it is a highly effective method of stopping outbreaks before they become unmanageable. In order for contact tracing to be effective, though, the public has to cooperate and comply with public health measures.

Stopping an outbreak before it’s a pandemic

Ultimately, public health officials want to keep as many people as possible from getting sick. Strategies to try to contain an outbreak include isolating patients with confirmed cases, quarantining those who have been exposed and, if necessary, imposing travel restrictions. For cases involving animal-to-human transmission, such as bird flu, containment measures may also include strict protocols on farms to prevent further spread.

Health officials use predictive models and data analysis tools to anticipate spread patterns and allocate resources effectively. Hospitals can streamline infection control based on these forecasts, while health care workers receive timely updates and training in response protocols. This process ensures that everyone is informed and ready to act to maximize public safety.

No one knows what the next emerging disease will be. But public health workers are constantly scanning the horizon for threats and ready to jump into action.

John Duah, Assistant Professor of Health Services Administration, Auburn University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The U.S. House of Representatives has passed a bill that would empower the Treasury Department to eliminate the tax-exempt status of any nonprofit it deems to be supporting terrorism. The Stop Terror-Financing and Tax Penalties on American Hostages Act was approved in a 219-184 vote, with all but one Republican backing it and only 15 Democrats voting for it, on Nov. 21, 2024.

The Conversation U.S. philanthropy and nonprofits editor Emily Schwartz Greco spoke with Beth Gazley, an Indiana University scholar of nonprofits, local governance and civil society, to better understand the outcry over this measure – which would have to pass in the Senate before a U.S. president could sign it into law. President-elect Donald Trump, who will take office in January 2025, will begin his second term with narrow majorities in both chambers of Congress. That means an identical or similar bill could come across his desk after being reintroduced in the next Congress.

Why are so many people concerned about this bill?

I believe that this is part of a strategy to preempt opposition to Republican policies and encourage self-censorship. It’s a way for the GOP to try to restrict what activists and nonprofit organizations can say or do. And, essentially, it’s a threat to political opponents of President-elect Donald Trump.

This kind of law could become a blunt sword that can be used against everybody.

I’m not the only one who feels this way. U.S. Rep. Jamie Raskin, a Democrat who previously was a constitutional law professor, called the bill “a werewolf in sheep’s clothing.” Raskin observed that “rendering support to terrorists is already a felony” and warned that this bill could end up “capsizing” all rights to due process.

Several nonpartisan groups and associations representing a wide array of nonprofits, including the Council on Foundations, Independent Sector, the National Council of Nonprofits, and United Philanthropy Forum, issued a joint statement that condemned this measure ahead of its passage in the House. The groups said they were concerned that it would provide “the executive branch with expansive new authority that could be abused.”

What do you think ‘terrorism’ means in this context?

An earlier version of this legislation was introduced in December 2023 and passed in the House in April 2024. Based on the timing, it was widely interpreted as an attempt to quell widespread protests by students and other people who were expressing their solidarity with Palestinians and their objections to Israel’s military operations in Gaza.

But this legislation could easily do far more than that because it does not distinguish between foreign and domestic terrorism – whether it’s real or imagined.

Until now, the Treasury Department has taken great care in how it defines domestic terrorism, observing on its website that the Constitution and U.S. laws “protect a wide range of expression – even expression that many might disagree with or find abhorrent, and even expression that certain foreign allies and partners of the United States prohibit and criminalize under their own laws.”

U.S. law stipulates that The Treasury Department has an obligation to remain nonpartisan in any of its interactions with tax-exempt organizations.

As a result, making it easier for federal authorities to allege that a nonprofit is “terrorist” would be a big departure from American traditions. It could be turning the term into a kind of political rhetoric that’s meant to intimidate activists, including those holding campus protests.

The lack of a clear definition in the legislation would leave room for interpretation. It’s not clear who would be held liable – it might even be the nonprofits’ donors.

Constitutional protections may protect people in the end who get caught up in these allegations, but there’s no way to know how far this could go or how much it might upend their livelihoods while they defend themselves.

What other concerns do you have?

This bill reminds me of what’s happening around the world in countries where support for democratic principles is declining and right-wing governments are restricting dissent.

I’m currently working with Jennifer Alexander, a public administration professor at the University of Texas at San Antonio, on a paper about this trend and how it’s tied to what’s already happening in many U.S. states. We’ve found this pattern most prevalent where the Republican Party has full control over the government – the GOP occupies the governor’s mansion and has a majority in both legislative chambers.

We have found that at least 22 U.S. states have either passed new laws restricting protests or tightened laws that were already on the books, increasing the severity of possible punishment. These laws restrict public advocacy and organizing.

I can see it being used to clamp down on environmental protests, like the ones held in Atlanta to object to the construction of a police training center in an urban forest, or in North Dakota, against the construction of an oil pipeline.

This kind of measure could lead to more severe crackdowns, should there be a new wave of Black Lives Matter protests, similar to the ones in 2020 that followed George Floyd’s murder. Many of those demonstrations were organized by nonprofit groups.

In Texas, state authorities have attempted to shut down charities that assist immigrants, leading to an outcry from civil rights groups.

And Indiana Attorney General Todd Rokita has launched a probe of companies and nonprofits, including the God Is Good Foundation, that have allegedly conspired to bring noncitizens to the state.

What do you think would happen if this measure were to become law?

I can see how people intending to continue with the kind of mass mobilization organized by nonprofits might decide to go underground – to avoid the repercussions of activity that I would argue is clearly protected by the U.S. Constitution.

Even without this measure becoming law, it has become possible for an organizer to be held liable in court for damage or injuries incurred during a demonstration – even if they personally did not engage in violence or destruction.

Officially labeling an organization as “terrorist” can be very powerful. If this were to start happening, some of the population would never see that group any other way again.

Many authoritarian regimes like to use this propaganda tool because it makes the public distrust those organizations. It places these organizations outside acceptable norms of civic engagement, despite nonprofits’ right to freedom of speech, assembly and petition embedded in the First Amendment to the Constitution.

Beth Gazley, Professor of Nonprofit Management and Policy, Indiana University

This article is republished from The Conversation under a Creative Commons license. Read the original article.