PyDOSS: An open-source Python-based communicable disease outbreak surveillance system designed and used in a COVID-19 community care facility (Preprint)

Abstract

BACKGROUND During the Coronavirus Disease 2019 (COVID-19) outbreak, community care facilities (CCF) were set up as temporary out-of-hospital isolation facilities to contain the surge of cases in Singapore. Confined living spaces within CCFs posed an increased risk of communicable disease spread among residents. OBJECTIVE This inspired our healthcare team managing a CCF operation to design a low-cost communicable disease outbreak surveillance system (CDOSS). METHODS Our CDOSS was designed with the following considerations: (1) comprehensiveness, (2) efficiency through passive reconnoitering from electronic medical record (EMR) data, (3) ability to provide spatiotemporal insights, (4) low-cost and (5) ease of use. We used Python to develop a lightweight application – Python-based Communicable Disease Outbreak Surveillance System (PyDOSS) – that was able perform syndromic surveillance and fever monitoring. With minimal user actions, its data pipeline would generate daily control charts and geospatial heat maps of cases from raw EMR data and logged vital signs. PyDOSS was successfully implemented as part of our CCF workflow. We also simulated a gastroenteritis (GE) outbreak to test the effectiveness of the system. RESULTS PyDOSS was used throughout the entire duration of operation; the output was reviewed daily by senior management. No disease outbreaks were identified during our medical operation. In the simulated GE outbreak, PyDOSS was able to effectively detect an outbreak within 24 hours and provided information about cluster progression which could aid in contact tracing. The code for a stock version of PyDOSS has been made publicly available. CONCLUSIONS PyDOSS is an effective surveillance system which was successfully implemented in a real-life medical operation. With the system developed using open-source technology and the code made freely available, it significantly reduces the cost of developing and operating CDOSS and may be useful for similar temporary medical operations, or in resource-limited settings.