Transcriber: Yike WANG
Reviewer: Hiroko Kawano
In the beginning,
okay, of the 20th century,
we had a lot of fear -
fear that was stoked
by the surprise of natural disasters.
Back then,
our communities would be surprised
by a tornado or flooding or hurricanes.
In this particular slide here,
I'm showing you
the worst natural disaster
that we had experienced
in the last hundred years,
actually worse than Katrina.
And this was Galveston, Texas,
when it was hit
with a Category 4 hurricane
for which they didn't have forecasts.
They didn't have effective warning.
They just saw some dark thunderclouds.
And everyone stayed
in the town on the island.
8,000 to 12,000 people were killed.
And if you think about that,
there were so many dead bodies
that they had to put them on those carts,
roll them out to a barge,
and dump them into the sea.
It was a catastrophe.
And you say to yourself,
"How the heck could that have happened?
Why did it happen?"
We just didn't simply have
the discipline or the technology
to anticipate these events.
We really take that for granted today.
So this is the formation of a tornado.
We take it for granted
that we have a radar system.
We just turn on the TV,
we can go to our mobile phones,
and we can see this literally anywhere.
Look at this - this is
the formation of a hurricane.
We have come to expect as a society
that we will be given forewarning,
that we will be able to take
that into account in our daily lives
to protect our family,
to protect our friends,
to protect our property.
You expect to get a warning
if we have a tornado
in this city, for instance.
But what we've seen here in the last,
I would say about 25 years,
is we've been hit with a number
of surprises in infectious disease
that are remarkably similar
to what we saw in the early 20th century.
We keep getting surprised.
Ebola was the most recent surprise,
a rather ugly surprise
that I was involved with on our end,
where we were asking really
uncomfortable questions such as:
"Is this virus,
which is spreading at an absolutely
unprecedented rate in West Africa -
did this thing mutate?"
Now, I've worked these issues for years,
about 20 years, in fact.
I led the team that provided
warning of the swine flu in 2009.
I led a team that went into Haiti
and tagged the UN
as the source of the cholera disaster.
These were scary events.
These were events with uncertainty.
And it's always easy to go back and say,
"Oh, these weren't
such a big deal after all.
SARS was overblown.
MERS, overblown."
But at the time,
there was tremendous uncertainty,
and if you really think about it, fear -
the foundation of fear and anxiety
and all the stock market shifts
we see around these events
and all the insurance policies
that are invoked around these events
and all the industry that's threatened,
all the social sense of well-being
threatened.
The foundation of all
of this fear is uncertainty.
But I say,
"Eh, I think we can fix this."
So in the beginning in the late '90s,
we began using satellite imagery
to try to forecast Ebola.
We did not have a statistically
significant sample size.
It was a gut instinct.
And we were sitting there
in the rainforest, drinking stale beer
and trying to figure out,
"Where the heck did this virus come from?"
We had monkeys crawling around
all over the canopy above us,
and Ebola had been in that area.
In fact, it was within a stone's throw
of the Liberian border.
It was a prelude
to what we would later see.
And what we were looking at was:
Is it possible that Ebola could be somehow
tied to drought in the rainforest?
And if we knew that,
and if we could track it
using satellite imagery,
could we then issue a forecast
that could be given
at the right time, at the right place,
to people to say,
"Please, for heaven's sake,
don't eat bush meat
for the next two weeks."
And that simple advisory
avoiding a catastrophe
that frightened the entire planet,
as we just witnessed.
What if?
But we do forecast.
This is actually what we forecasted
with a 21-day forecast window
for Sierra Leone in cases of Ebola.
Our accuracy was 0.8%
of what was ultimately observed.
Don't tell me we can't
forecast this stuff.
So the secret here that is being revealed
is that we actually do have a national
infectious disease forecast center.
It's what I was invited
to this state to bring
the operational footprint of.
We do have a national weather
service for infectious disease.
We've actually had it for quite some time.
Regrettably, it's taken us some time
to go fully public with it,
but what you're seeing right here
are the actual advisories.
Actual advisories for salmonella,
a disease that produces
about a million cases a year,
19,000 hospitalizations,
and about 380 fatalities every year.
Not as bad as influenza necessarily,
but it dominates the media, right?
So right now, we're seeing reports
of cucumbers being a threat, right?
We've had a few fatalities
related to that, okay?
We just witnessed a CEO
of the Peanut Corporation of America
get an unprecedented prison
sentence of 28 years
for his role in the salmonella outbreak
in the mid-2000s that killed some folks.
So this is a pretty important pathogen.
And all of industry has been sent
a warning from the federal government
that basically, enough is enough.
We need to get ahead
of these problems somehow.
Partly cloudy skies
with a chance of diarrhea.
(Laughter)
But look at this map.
Hotspots, just like a weather map.
I'm telling you a forecast.
So we just moved in that figure
from the colorized portion
of the last two months
into the black and white,
which is the plus two months.
That was an actual forecast
that was validated,
or is validating, I should say.
(Chuckle)
So the question here is:
If I gave you your forecast,
would that change anything,
one iota of your behavior?
I'm counting on a yes to that.
If you think about meteorology,
everybody uses weather data
in their daily lives to different effect.
An entire national population
is using that data to some degree.
If you think about it,
it's almost innocuous.
You don't even think about it.
And yet, it has altered
our entire society -
the use of meteorological data.
Guess what, folks?
There's another bit of data
that's about to change our lives.
Welcome to your national
infectious disease forecast center.
Partly cloudy skies
with a chance of chicken pox.
Woohoo!
Here goes forecast mode,
here in black and white,
with a chance of an ulcer, syphilis.
You notice that the Southeast
of the US is a problem area?
(Laughter)
No one from the South, I hope.
Streptococcus - bacterial
pneumonia, in other words.
Rabies in animals.
A potentially lethal disease
if you get exposed to it
and don't think of rabies.
Whooping cough.
Pacific Northwest,
please, for heaven's sake,
vaccinate your kids.
A subject of another TED talk:
vaccination.
We won't go there.
Meningococcal disease,
a rare but potentially lethal disease.
See that in the media, right?
So what if I told you your state
is turning into a hotspot?
What would you do?
This is Lyme disease here.
Would you contemplate vaccination?
Would you contemplate
putting on insect repellent?
Chlamydia - the gift that keeps on giving.
(Laughter)
Well, doing what I do,
I have to come up with jokes.
This is quite depressing,
actually, at times.
So we say, "Fine."
I start to release these forecasts
for literally any disease 
you can imagine now.
What would you do differently?
Would you think twice
about eating that raw cookie dough?
I've got to tell you
that's a problem for me
because I'm not going to lie.
I love chocolate.
It's sad.
Would you think twice about letting
your child play with that stray cat
if we gave you a forecast for rabies?
Would you think twice
about your stance on vaccination?
Compelling questions, huh?
Let's keep going.
We give you the world.
Japan,
Taiwan,
Singapore -
these are real forecasts -
South Korea,
Hong Kong,
Germany,
France,
England,
Australia,
Brazil.
These were all different diseases.
Everything from tick-borne encephalitis
to scrub typhus to cholera
to tuberculosis to AIDS.
You don't believe me?
That is the forecast right now,
standing, for Japan
and their diagnoses for AIDS.
And, yes, we can forecast those diagnoses.
It's heady stuff
to think about "What would you do
with this kind of information?"
How about drug resistance?
This is drug-resistant
enterobacter for Japan.
We forecast this down
to the prefecture level.
In fact, we have forecasts for 70 diseases
down to the prefecture level.
Japan, if you are listening,
I will tell you, you have
a national forecast center.
I apologize for the late notice.
I'm notifying you of this right now.
Your hospital.
So an interesting phenomenon
in the United States and really elsewhere
is sort of the question
of "Who owns the data?"
It's a big question.
It's kind of stinky too
because electronic medical records,
the vendors that have those systems,
the hospitals, the lab systems -
all of our data is hoovered 
up into these systems.
And the question is: Who owns that data?
I'm asking because I can turn
a hospital into a forecast station
that can help you.
MRSA, ear infections.
I'll just let this keep scrolling.
You can read these diagnoses.
Some of them you may not understand.
The point is is I can take a hospital
and in two hours flat
give you 200 forecasts for 200 diseases
that may have infectious disease
ideologies behind them.
RSV.
So how many folks here are parents?
Had a toddler with RSV? Anybody?
It's a scary disease, isn't it?
Appendicitis, herpes, pericarditis,
inflammation of the heart lining.
We can just go on and on and on and on.
I can't do this if I don't get
access to the data.
So you take a hospital,
you start producing these forecasts.
One of the things we
learned pretty quickly -
by the way, this is infant, children,
and adults going from left to right.
One of the things we were able
to learn fairly quickly
is that the point of reassurance
to an anxious parent
is incredibly powerful.
If I have a mom who comes in,
and her child has blisters
on the palms of their hands and feet
and their throat just looks raw
and they've been running 
a temperature of 104.5
and that mom has been up all night long
and this kid is acting like
they're trying to die on them.
And I can say, "No, this is consistent
with hand, foot, and mouth disease,
typically caused by coxsackievirus.
It's a mild disease.
They will recover.
No, we don't have a vaccine.
And by the way, this was forecasted.
This is utterly routine.
Sometimes not, but most of the time yes.
So the power to reassure people
that these are routine diseases
and this part of our biorhythm
in the community is so powerful
and avoids so much unnecessary
cost and expense of the anxious
who are all coming into our clinic.
It's worthwhile.
But let's talk about another problem.
I've investigated some
of the world's largest bioweapon attacks,
some of which are not public knowledge.
I have been on the frontline
to provide warning
of pandemics, lab accidents.
I've been involved in investigations
of the warning failures
related to SARS and MERS.
I've been involved in some pretty
darn scary things in my time,
right there in real time.
And I'm often asked,
"What is the number 1 threat
that scares you the most, James?
Is it Ebola?
Is it SARS?
Another SARS, maybe?
Is it the nanobots?"
Apparently, there are
nanobots out there too.
Now, I could go on and on and on
about what could be out there.
But no.
This is actually a display of data
right here under our very
feet in this county.
One of the hospitals who,
courageously I should say,
gave us access to their antibiograms.
"What are antibiograms," you say?
Well, this is the profile
of drug resistance in that facility.
They courageously gave it to us
so that we could produce forecasts.
And these forecasts can then tell us
where are we headed
with our drug resistance problem
in this county.
This is E. coli,
the number one cause
of urinary tract infections.
We go through a billion dollars
every six years in this state alone
hospitalizing folks
due to urinary tract infections.
This is the number 1 drug
prescribed for UTIs,
urinary tract infections,
in the emergency department
at this facility.
It is known as Cipro.
We lost the ability to use Cipro in 2005.
So I ask the audience,
"What in heaven's name are we doing
continuing to prescribe this?"
The answer is simple:
If you do not measure it,
how can you manage it?
This is the only system in the world -
based here in Reno.
It's cloud-based, fully automated,
and it can take a hospital,
and forecast its drug resistance
profile in 32 seconds flat.
So what would you do with a forecast?
It's a question,
and I can guarantee you
that the answer that comes
from that question is different
if I'm talking to a physician,
hospital administrator, a school nurse,
a mom, a dad,
an airline pilot, stewardess.
If you really go far outward
in your thought process
and think of how many different ways
this could begin to influence behavior,
you can't get your head around it.
I've been doing this 20 years -
I still haven't got my head around it.
Delta Flight 191.
Those of us who are a little bit
older remember that day in 1985
when a full aircraft was inbound
at DFW Airport in Dallas.
The pilots ignored a forecast
calling for a severe thunderstorm.
They decided to fly
through it on their approach.
They hit a microburst,
and the microburst pancaked the aircraft
into the ground ahead of the tarmac,
killing most of the people onboard.
Millions of dollars in lawsuits.
The courts found that 
Delta Airlines was responsible
because the pilots
had access to a forecast
and chose to ignore it.
It changed the airline industry that day,
the thought that we could actually
forecast microbursts from now on.
You have just heard a talk
announcing to the entire world
that we now have operational
forecasts for infectious disease.
There are no more excuses.
We can get ahead of drug resistance,
we can get ahead of these outbreaks,
we can get ahead of these epidemics,
and we can dispel the fear
once and for all.
Thank you.
