Some decisions in biosurveillance are not difficult. When a staff member of a health department receives a report of a case of measles, for example, the appropriate response may be so straightforward that the staff member may not even perceive it as a decision. An easy decision is one that an individual makes regularly, that an individual has been trained for, or that does not involve a great deal of uncertainty.
Some decisions can be quite difficult. A difficult decision is one in which the best course of action is not clear. Examples include decisions about what actions to take in response to anomalies in surveillance data that are suggestive, but not conclusive, of the existence of an outbreak; decisions such as
Should I wait another day to see if the trend in the surveillance data continues?
Should I ask the city's emergency departments to collect more data?
Should I initiate a formal investigation?
Should I request assistance from experts?
Should I begin to mobilize treatment resources such as the national strategic stockpile?
Should I issue a public advisory?
Difficult decisions involve tradeoffs between the costs and benefits of action versus inaction. The most difficult decisions are those in which the costs and benefits are denominated in units of human health and lives. Thompson et al. (2005) classified different categories of decisions that have to be made in a short period of time by various individuals and organizations.
To make this discussion concrete, we focus on the decisions faced by a biosurveillance organization when faced with evidence of an environmental contamination or of a potential disease outbreak. Cryptosporidium outbreaks have occurred in the recent past or have been suspected from environmental data. We focus our discussion to decisions that have arisen around this disease sufficient published information about this problem is available to support a decision analysis.
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