Thursday, January 08, 2009

CellPhone Microscope

CellPhone Microscope
Andre Willers
8 Jan 2008

A Critical Invention .

See the excellent "Best of what's new 2008" in PopularScience Dec 2008 , p83-84 .
(Get the issue – actual hardware , most of which is available commercially)

The CellScope is a microscope that can be fitted to a cellphone , giving (at present) 5x to 60x magnification . The image can then be sent via cellphone to central diagnostic centers .
Developed under leadership of Daniel Fletcher , a bioengineer at the Uni of California at Berkeley . Response time can be as low as 10 minutes .

This is sufficient magnification for malaria , TB , melanoma's , etc .
This has been field-tested in DRC in Aug 2008 .

Why is it important ?
1. Quarantine
It is still the only reliable tool for prevention of pandemics . For that early diagnosis and triage is essential .

After the SARS and BirdFlu scares , numerous models were run .
The critical factor in limiting mortality was the speed of the quarantine response .
Historically , (eg Black Death) , about 50% - 67% of a virgin population can be saved if strict quarantine measures are applied .

The problem is , in the present world economy , this will cause as many if not more deaths from economic collapse (ie starvation , lack of power , etc) .

A speedy triage system is essential , identifying the non-infected and notifying the quarantine system .

Waiting for normal tests take too long .

Quarantine in dubious cases have to be applied immediately .

2. Do not kill off your medical personnel .
A real nasty kills the medics first . (Some biowar organisms were engineered for this : see Alibek et al)
This is a feedback mechanism that makes the casualty count much higher than it need be , as opportunistic diseases flourish .

A present example :
At the present moment , there are literally hundreds of thousands of refugees from Zimbabwe in Southern African states . An unknown number have cholera .

The major worry is that real nasties like Ebola , Arena-viruses , etc evolve in the weakened refugee population to less lethal forms .

(High-lethality forms kill the hosts quickly while still near home . Less lethal forms linger on to infect more people ie more successful from the viewpoint of the virus . These replicate . An Evolution Machine .)

Letting even one carrier loose condemns a large number of people to an agonizing death . And the time window is an hour or two .

Rapid triage diagnosis (ie at least , saying that it is not a haemorhagic virus) is essential .

This can be done by anyone with a WiFi Cellphone camera and CellScope . A central diagnostic facility (like PathCare or Govt) can do diagnosis and trigger triage if needed .

This technology will become essential in the near future .

Technological advances :
1.The magnification of the microscope will increase as the pixel count of the cellphone camera's increase .

2.Computerised diagnostics .
Not liked by the medical fraternity , because it can do a better job on average than doctors . (Ie a good doctor is better than a program , but a good program is better than a mediocre doctor.)
See also " Small PC Specs"

But it will become essential in triage in pandemic situations .
Remember , BirdFlu is still waiting in the wings .

The triage can then be done right on the spot by laymen , using the CellScope and diagnostic software in the camera . Anything doubtful gets kicked upstairs to a diagnostic center.
Note that extremely infectious diseases like the haemorhagic fevers causes disproportionately large casualties in the medical staff , something that can be ill afforded in a real emergency . (Eg the recent case of Arena-virus in Johannesburg , where the three ancillary deaths were all medical staff.)

3. General Costs in gentler times :
A good doctor will prefer immediate triage of his patient .
It is vastly cheaper .

Most cases are not serious , but to be certain , expensive tests have to be run .

He can offer the patient his opinion (cheap , using diagnostic systems) , a more expensive referral to a diagnostic specialist at the image center , or an even more expensive classical bloodwork (and the guidelines of PathCare , for instance , are computerized diagnostics . Most doctors do not even look beyond them .)

Why do you think that many patients trust their own researches on the internet more than their doctor's opinion ? Because they know that he only had to pass with 50% marks , and has forgotten half of what he once knew .
Any mistakes get buried and covered up by the Medical Association .

And any Interesting Case is Idiosyncratic .

The perfect modern epitaph:

"Here lies the Internet dynamic
Alas! His vitals are all static . "

And so it goes .


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