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You're aching, you're shivering, you're coughing. You're definitely, miserably sick, but is this real, potentially serious flu or just some garden-variety winter crud?
Better find out. You pull your handy-dandy virus test kit from the shelf, insert the nasal swab gently into your nostril and twist it around three times to coat it with your (copious) mucus. You swish the swab in liquid and deposit drops of your germy mix on the four wells of the instant test. Ten minutes later — voila. Sure enough, you test positive for an influenza type A. You call your doctor to ask about anti-viral meds, and — as a good citizen of your disease-tracking community -- you go online to report your diagnosis to Flu Near You. On its map, you see that you're not alone: a dozen of your neighbors have the same bug.
Futuristic? Not if you live in the Boston area and are part of a new flu-tracking experiment funded by the National Science Foundation, called GoViral. Run by researchers at Boston Children's Hospital, the three-year project is just getting under way now, as this year's flu season takes on steam.
Flu is more than a nuisance. It's a serious threat — infecting tens of millions of Americans a year and killing an average of 24,000 — and public health types try hard to track and understand it. The CDC monitors reports from doctors' offices, including lab test results. Google Flu Trends watches online searches for telltale symptoms. Flu Near You, where GoViral is based, already brings together thousands of volunteer sentinels who report online when they have symptoms. Now, GoViral will take testing into the home, where many flu patients hole up rather than seeing the doctor.
"It’s never been done before, to give a lot of people in their homes these tests," said Dr. Rumi Chunara, GoViral's lead researcher. "This is the first time that we're actually crowdsourcing diagnostic samples from people."
The project breaks new ground in flu tracking, said Dr. Lyn Finelli, who leads flu surveillance and response at the National Center for Immunization and Respiratory Diseases at the CDC: "This is the first time that I know of that anybody has used what we call participatory surveillance," she said, "where people indicate whether they're well or ill, and participate in home testing and send the tests in. This is a very novel look at a surveillance system and home testing."
Dr. Chunara plans to distribute several hundred free flu test kits to Boston-area members of the public who sign up (here) this winter, and expand to encompass more areas next year. The kits include the rapid test, which can only check for four common viruses but gives an instant answer, and also a saliva test that must be sent in to a laboratory and can reliably detect 20 common viruses (though you may be better by the time you get the result.)
The rapid tests are not perfectly accurate, Dr. Finelli noted, "but during flu season, they perform very well in that a positive is a positive." Sometimes a test produces a false negative — saying you don't have flu when you really do --"but if you have a positive test, you can count on it during flu season," she said.
So if you test positive, what do you do? Are you likelier to stay home from work or school? To ask your doctor for Tamiflu? To remind your loved ones to get vaccinated? Among their goals, the GoViral researchers aim to see how home flu tests affect behavior.
Similarly, what if you're not sick but you look on the Flu Near You map of your community and see a mass of red dots at your children's school or your friend's workplace? Will you become that much likelier to insist on hand-washing and mouth-covering during coughs?
Part of the point of tracking is to help people prepare, Dr. Finelli said. "And so as we see flu in a community start to increase, we can tell people to get vaccinated, and also tell people, if ill, to call their health care provider and see if antiviral agents are indicated. Anti-viral agents can decrease the number of complications and decrease the number of days you're sick with flu."
Nationally, flu activity has increased sharply over the last week, she said, and is expected to keep rising over the next few weeks. (But there's still time to get vaccinated, she emphasized.)
Though flu is extremely common, much remains to be understood about how, exactly, it spreads. That, too, will be a focus of the GoViral analysis.
"Even though flu happens every year, we still don't have a good idea of how many people are getting it, who are the groups most at risk," Dr. Chunara said. Now, "from a scientific point of view, we can go right to people and be able to understand, what kinds of groups did get the flu? Who was most at risk? And we can map these things out and look at where things were happening and at different times over the course of the season."
Understanding those dynamics better could help prepare not just for run-of-the-mill flu but also for a pandemic, she said. "The more we learn, the more prepared we'll be."
On a personal note, I fear flu like the devil. In 2008, the brilliant, buoyant and otherwise healthy teenaged son of my oldest friend died of flu complications. Afterward, steeped in fear for my own children every winter, I fantasized about creating some sort of classroom reporting system so that I wouldn't feel forced to gossip with other parents about who was sick and with what symptoms.
Flu Near You is that kind of tool — and Go Viral adds an element of certainty about the diagnosis. I asked Dr. Chunara if it makes sense to recruit people from my own circle of acquaintances. Yes, she said: "You want to know what's going around right around you. Then you'll learn a lot more about what could happen in terms of risk."
So I signed up my own family for GoViral, and I've already passed along extra test kits that Dr. Chunara left with me to two of my friends. One, a budding scientist who recently suffered through a bout of possible flu that included vomiting, responded: "I'm perversely hoping that nausea will strike again so I can use all those cool vials in the test kit..."
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