In any public health crisis, time is the most critical resource. Whenever need overwhelms capacity, committing public health professionals to the fight effectively and efficiently is a top priority.
“When there is an outbreak, you have to move people off other critical public health functions,” said Dr. Paul Jarris, chief medical advisor for the MITRE Health Transformation Center in McLean, VA. “We wanted there to a be a tool that could be ready at the beginning of the outbreak.”
With the support of the CDC Foundation, MITRE partnered with the Association of Public Health Laboratories (APHL), and local, state and federal agencies to develop Sara Alert, a standards-based, open-source tool designed to support monitoring of individuals at risk of developing COVID-19.
Dr. Paul Jarris, chief medical advisor, MITRE Health Transformation Center
The Development of Sara Alert
As an automated contact tracing system, Sara Alert allows those under quarantine to enter their symptoms daily using a phone or computer from their own homes, eliminating the time-intensive daily calls or house checks traditionally required of public health professionals. The self-reporting system allows contact tracers to keep tabs on a much larger number of people while focusing on those cases that pose the highest risk.
Jarris says the impetus behind Sara Alert arose from his own experience over more than 17 years working on public health outbreaks, where there were often not enough human resources available to provide effective monitoring and rapid response.
“We did not have a way to do case contact tracing or support people in quarantine and isolation efficiently and at scale,” Jarris said. “Sara Alert allows us to automate and modernize identification and monitoring of case contacts in quarantine, and positive cases in isolation.”
Developed by engineers at MITRE, a not for profit, in partnership with public health professionals at APHL, Sara Alert first launched in April 2020.
“APHL is providing the technical infrastructure for hosting Sara Alert on the APHL Informatics Messaging Service (AIMS) platform, a cloud-based hub that connects federal agencies, hospitals and state, local and territorial public health jurisdictions,” said Scott Becker, chief executive officer, APHL. “AIMS is assisting with nationwide data housing as well.”
From the AIMS platform, public health officials from all 50 states, as well as territories and tribal locations, can access and share the information in real time, replacing the slow and time consuming pen and paper reporting systems used in the past.
“Standing the system up at AIMS, a cloud-based platform that was so trusted, saved probably six months of work,” Jarris said. “So the CDC Foundation’s support was very critical, and critical at a critical time.”
It’s quite remarkable how the CDC Foundation has become such a critical player in the COVID-19 response. There were voids that needed to be filled, and the Foundation was able to fill them.
From Launch Day Onward
Once launched, Sara Alert’s impact was immediate. “The ability for health departments to monitor those at risk and advise appropriate isolation measures and care is critical,” said Becker. “This work is providing public health agencies with real-time data, ensuring they can respond quickly to contain the spread of disease.”
Within a few months of its launch in the Commonwealth of the Northern Marianna Islands, more than 75,000 people from 14 states and counties across the United States had enrolled. As more public health officials began using the system, MITRE’s engineer and public health team used feedback to adapt the platform, for example allowing users to report their symptoms in foreign languages. Such adaptability, Jarris says, is a key element of the system’s design.
“It’s built agnostic to the disease,” Jarris said. “Right now, it’s configured to COVID-19, but with database changes it can be configured to any future pandemic and stood up on day one.”
To allay privacy concerns, the system is not designed to track users’ locations, nor is it downloaded onto user phones. The privacy it provides ensures the full confidence of users— essential if the system is to be effective.
Overall, Jarris says, the Sara Alert system is an idea whose time has come, and one whose genesis was in part made possible by the timely intervention of the CDC Foundation.
“It’s quite remarkable how the CDC Foundation has become such a critical player in the COVID-19 response,” Jarris said. “There were voids that needed to be filled, and the Foundation was able to fill them.”