In The Arena by TechArena - Technology’s Role in the Fight Against Zootonic Pathogens with WSU’s Pilar Fernandez

Episode Date: August 1, 2023

TechArena host Allyson Klein chats with Washington State University professor Pilar Fernandez about how her team’s battle for better information about the spread against Lyme disease and other zootonic pathogens and how technology is arming the public with better data to keep individuals safe with this growing epidemic. Dr. Fernandez and fellow scientists have tapped advanced analytics and AI to track tick populations and enable proper identification of tick species as part of a larger community effort to fight this growing disease.

Welcome to the Tech Arena, featuring authentic discussions between tech's leading innovators and our host, Alison Klein. Now, let's step into the arena. Welcome to the Tech Arena. My name is Alison Klein. And today we're going to be talking about the intersection between technology and disease prevention and care.

And I've got a really exciting guest with me, Dr. Pilar Fernandez, an assistant professor at the Allen School of Global Health at Washington State University and a disease ecologist. Welcome to the program, Pilar. Thank you for the invitation. So Pilar, why don't we just start out and say, what does it mean to be a disease ecologist and how does that relate to the topic today? Yeah, so ecology really means studying the interactions between different species, how the species interact with each other, and how they interact with the environment. And we can do that at different levels. We can do it at the population level, at the landscape level, community level. So there's different levels of study. And disease ecology, in particular, focuses on studying diseases as an ecological phenomenon,

which is basically the interaction between species that are susceptible to infection, the pathogens, which are another species in itself, and how they interact with each other and how they interact with the environment. So we approach transmission of diseases from that perspective. Now you focus in particular on tick-borne illnesses. And of course, the illness that got my attention that you've studied is Lyme disease, just because of its prevalence in the United States and some work that you did on a TickB bite app that we'll get to in a minute, but why don't we just start, why ticks and why are these illnesses so important to study right now? Yeah, so we can think about the importance of diseases that are being transmitted from animals to humans, which are called cyanotic diseases. And we have a great example with

SARS-CoV-2 and COVID, which is the zoonotic diseases. Those diseases from newly emerging diseases, 75% have a zoonotic origin, means that it originates in animals. One mode of transmission of these diseases are through vectors. And ticks are vectors, which means they can pass disease from an infected animal to another infected animal, including humans. And so my main focus is trying to understand how that transmission happens, who is maintaining the transmission cycle in the wild, and how humans get exposed to it and what is leading to those interactions between those species and the environment that leads to the expansion of the disease in its geographic range, but also how are humans getting in contact with the disease.

Now, ever since the 1970s, when Lyme really entered into the public awareness in the United States, the epidemic has been growing. It's not necessarily just associated with the Northeast anymore. What is causing that expansion? And I read something like crazy that Lyme is in almost every state at this point in the union and all over the world. And obviously there are other tick-borne diseases at play across the globe as well. What's causing this growth? So the honest answer is we're not sure. There are many things that are happening that could lead to that expansion.

Obviously, since it was first described, it has been expanding. We know that there has been an expansion of the tick. So one is, there's two things that needs to happen. One is the expansion of the vector, in this case, the ticks that can be present in new environments and survive in new latitudes or new areas where they didn't used to exist. And then with that, also the pathogen needs to be able to get there and establish a transmission cycle. And in the case of Lyme disease, it's the Borrelia rudorferi bacteria. What is mostly driving the expansion of the disease is the expansion of the tick. And for that, the ticks need specific environmental conditions to be able to establish.

But also for the disease to be established, there needs to be other hosts that can maintain that tick population, for example, deer. So there has been, obviously, environmental conditions have changed, keep changing. So that can lead to the expansion of ticks in new latitudes where maybe they were not possible to overwinter in the past. And also the expansion of deer, for example, it's also important. In urban areas with the deer coming into and using urban environments and becoming more associated to humans because of the resources that we provide, that can also expand the ticks because ticks, especially adult ticks, need like deer to establish and continue their life cycle because they need a large blood meal from them. So if you don't have deer, it's not very likely that you're going to have ticks. So you need a

combination of things. It's just not the environmental and climatic conditions, but also which hosts are present. And we as humans are driving those changes. So when you look at what your scope of study is attempting to do, obviously it's in tracking the prevalence of ticks. But why? Why is this so important to the broader medical community? So one of the things that we don't know is where is that front of expansion happening? We know the places where it's established. We know there are Lyme disease cases there. And the question there is, how do we lower the burden of disease? Now, in our areas where disease is expanding, we really want to understand where that is happening,

where the likely places that you take populations are going to establish, because that alerts the medical population about being able to diagnose cases and be aware that the disease might be present there. Because if they don't know, it's not very likely they're going to diagnose it. So it's kind of different questions depending on where we're working on Lyme disease. But in that front of expansion, we're really interested to see where the disease might be expanding, where's the future direction of disease expansion, so we can alert the medical community as well. So we're in the midst of the hottest summer in recorded history, and I am sure you are tracking tick populations all over the place. Tell us the

state of the state in terms of where you're seeing ticks across the United States for our listeners. I'm sure they're interested. And do you find in working with communities, and I don't know if you've got an answer on this, that you've got some communities where doctors are less familiar or less prepared to address the medical conditions facing folks who might have had a tick bite. Yeah, we know that in areas that are considered endemic where the disease has been established there, the medical community is aware. And I wouldn't say that diagnosis is really an issue. Now, regarding the current summer, it's definitely a high tick summer in some areas, but not in all areas where you can find ticks. So that's the thing with the tick populations is that they don't all behave the same in the same way everywhere at the same time.

So you may have a very ticky summer, let's say, with high abundance in the Northeast or in like New York area, but maybe not so much in the Midwest and vice versa. So each population has its own conditions. And that's what makes tick-borne diseases so interesting because it's so complex because it has to do with the actual very localized conditions. So it's really hard to make really generalized predictions of what's going to happen across the U.S. because the distribution of the ticks and how they behave,

it's very focused in the local conditions. And also it's very dependent on, for example, what's the rodent community. So the immature ticks feed on mice and small battles, then they are also very sensitive to environmental conditions. So it's not just one straight answer is, oh, if it's going to be hotter, the stem is going to move in this direction and we're going to have an increase in ticks. And if it moves in this direction, it's not that intuitive. Okay. So we've got many different factors at play, broader urbanization into areas that used to be rural environments and bringing host populations

closer to humans, warming temperatures that may make it so that ticks can survive in climates or elevations that they couldn't before. And you're looking at this from a standpoint of trying to predict against that more complex landscape. Yeah. And the other question that we have, which I think it's really important, has been overlooked is how are humans behaving that might put them at risk of getting exposed to ticks? And that's where the tick out comes in because we have been focusing too much on the ticks, but we have ignored how people get exposed to it. And maybe you don't need that many ticks to really understand the human risk.

So it is a combination of both things happening at the same time, the number of ticks, but also how humans get exposed. Because if there's a huge number of ticks in the middle of the forest and nobody goes, then nobody's going to get exposed. And I think it's that encroachment between the natural areas and natural environments, people getting more in contact with nature and the development that we are doing, the suburban development that kind of looks for that contact with nature. But with that also comes the challenges, which is maybe I, yes, I want to be close to nature, but I don't want to get tick-borne diseases. Yeah. As an avid hiker, I can absolutely understand some of the risks associated with this because we all love going out into nature, but we don't like some of the consequences.

So you came to my attention because of an app that your scientific team developed to identify different species of ticks so that folks could identify if this was a tick that might be carrying a vector-borne disease. Can you tell me a little bit about that and why you decided to focus here? Yeah, so one of the challenges we have in studying tick-borne diseases is to go out and sample ticks and knowing exactly where they are establishing new sites. So we call that active sampling, which basically is that teams of researchers go out in the woods or in different places and look for ticks and collect them. That is very time consuming. It's very expensive because we can't be everywhere at the same time. But it's the only way to really get a good idea of what's happening

and where are the ticks now? What's the state of the ticks? Are we having a big tick number or lower tick in regards of the year? Another way to think about it is what we call passive sampling, which is using community science, which is basically asking the community to help us collect that data. And we thought it was like through the app, it might be easier to get that information

because everybody has a phone and everybody goes around, has a thousand apps. We know that also the challenges that we're competing with a lot of apps. But we thought maybe we can ask the community to help us collect that information as well so we can access places and be aware of the presence of ticks in areas where maybe we don't have a good coverage or we can't be everywhere at the same time. And also because, as I mentioned before, the tick populations are very sensitive to local conditions. So one thing happening in one location may be very different what's happening maybe in a neighboring county. We really want to capture what is happening,

where the ticks are expanding. Is it a low year? It's a high year regarding ticks. And so we leverage that technology to help people help us also do research on this. And the other aspect of the app that we're really interested in is to really understand what are the behaviors, the human behaviors that are exposing people to tics.

So in the app, we have questions not only if they found a tic and we ask them to take a picture, but also what were they doing, what type of activities, if they use any preventative measures. And questions like that really help us understand the human behavior. Now ticks, for those who have spent their entire lives in cities, ticks are really tiny, especially the nymph ticks that are most prevalent for spreading disease. They're very tiny. How is this app actually capturing a photo to be able to identify it? And I know that you guys used artificial intelligence to help identify the ticks. Can you tell me a little bit about that? Yeah. So that's the biggest challenge I would say. So when we first started, it was just, we asked people to take a picture and we have people in our team reviewing the picture and kind of deciding what type of species it is.

And obviously we have very different qualities of pictures that we get. Names are really hard. Names are the small ones that we usually get during the summertime. They're very tiny. And it really depends on, yeah, we have very different quality of pictures. So based on that, that experience, it's very time consuming also to go through all the pictures. So we thought about what if we use some image identification model

to help us classify those takes. So that will help us reduce the amount of work that we need to do and then have a more instant response to also the user. Now, there's a lot of challenges with that. And the main challenge is how do we standardize the tech pictures? Because these models are very sensitive to the quality of the pictures and the information you feed them. So if you feed them a really bad picture, they're going to have a really hard time identifying the text. If you feed them with really high quality pictures that can identify all the different features

that we use to identify the text, then it's going to make a job easier for the model, for us too, but it's, the model works the same way as we do, or they just looks at different features and decides what type of species it is. We kind of worked at the first iteration of that model, and that's what we're trying now, is we're training with pictures that we're taking to standardize it in a way that kind of feeds the model with the best quality pictures that we can get. So you trained on the good stuff. We train on the good stuff, but we also feed them with images that were not so good. And then we're using that model right now.

So that model is the one that we're using right now. And we're trying to get the best stuff, but we also feed them with images that were not so good. And then we're using that model right now. So that model is included in the app from a user point of view. You don't see the model. You don't see the instant result. Because this year, what we're doing is we're trying to compare. So we get the results. So when someone submits a picture, the model is running in the background and it gives us an answer. It says this is 55% probability that it's Ixosus capillaris, which is the tick that just meets Lyme disease, or it's 30% probability that it's this other tick species. And then from there, we still have a team of people going

and reviewing all those questions before we send the user an answer. Because this year what we're trying to see is, okay, how good is the model? And trying to adjust because it's an iterative process where we're trying to find out how good the model is before we actually let it work on its own.

And so far, it's really still very sensitive to the quality of the pictures. And so we're working on instructing people through the app with silhouettes and stuff on how to take better pictures and how to make better focus off the ticks. But I don't know, Pilar. I don't know if I want to get that close to a tick that might be carrying a bad disease. I can understand why some of the photos are not that great. I guess the question that I have, and that's fantastic, is if folks are listening online

and they want to download this app, they're going to be going out in the woods, they want to be able to do image classification, where do they find this application and put it on their phone so that they're ready? Yeah, so the app is free. We have an iOS version and an Android version. So it's both in the Google Play and App Store. So you can go there and download it for free. And yeah, help us with the research. And what would people search for to get that on their phones?

Zetik app. That's direct. That's nice. Yes. And then obviously this is not the only place that you have focused your study. We're talking to an audience of tech professionals. Where else can technology aid in your research and the research of teams across the world in terms of vector-borne diseases. Yeah, so the other area of research that we are exploring is how to predict these new areas of expansion. I think that is another key question that we have where we are using mathematical models to try to answer that question. And we have done some work on that using what we call, so we did hindcasting.

So it's not predicting future expansion, but we use data collected in the last two decades to see how the expansion of ticks based on what we know and how the system behaves really are capturing that area of expansion. And so we compare that predicted expansion with the observed expansion that happened in the last two decades, just to see how good our models were predicting that or what were the discrepancies between what we observed in terms of the reported cases and our model predictions. And when you look at that, what have you seen in terms of that expansion? Can you give a sense of how large of an expansion that's been over the last couple of decades?

Yeah. So it's hard to show it without the map. When you look at the maps, it has been really impressive. So it has been to obviously it was first detected in Connecticut. And I would say we took cases from 2000 when it was what we call the hot spots. So it were the most the areas where most of the cases were concentrated in the Northeast and some areas in the Midwest definitely has been an expansion towards the whole Northeast. So other areas in Vermont, Maine, New Hampshire that maybe were not so obvious before. We have seen an expansion from the Midwest hotspot. It definitely has been expanding from like Wisconsin into the Michigan-Pillains lab,

for example. So there has been a really broad expansion where these two hotspots has been really starting connecting and pretty much the whole Midwest Northeast right now with exemptions, but it's mostly tick areas. And when I mean tick areas, there are ticks all over the U.S. These are the main areas for Lyme disease cases. I see. Where, yeah, Ixosys capillarius, which is the tick that, or the black-legged tick, that is the tick that transmits Lyme disease, has been expanding. It doesn't mean that there are not cases in other states, but these are the main two RAS. Just the expansion in those two regions have been really impressive.

I read a statistic that almost half of the counties in the U.S. have had a case of Lyme detected, and that obviously Lyme is also in Europe. We see stories coming out of different parts of Europe with Lyme. When you look at where your research is going, and you think about where we started in the interview, the ecological changes in our environment that are driving that, what would you give in terms of folks in different populations as something to think about how they approach this and just like assumptions of where ticks are and where ticks aren't? Yeah, I would say there are different ticks and different RES. Again, we're talking about Lyme disease, but we can think about Rocky Mountain spotted fever, for example, other tick-borne diseases that also have their own different dynamics.

One of the things that I always say is, look, we're not going to be able to eradicate the disease. This is not feasible because the disease is maintained by wild animals. So the main reservoir of the disease is the black-footed mice. Realistically, when we're talking about zoonotic diseases, so diseases that are transmitted from animals to humans, it's not really realistic to think that you're going to eradicate the disease. We can control it to an extent. And I think the main challenge that we have is understanding how can we prevent those ticks to being in areas where they're closer to humans. So more suburban areas or urban parks and how to limit the human tick encounters in those environments. Now we're not going to be able to control tick-borne diseases in the middle of the woods.

I don't think that's even a feasible goal. But giving people tools to be aware where they might be the highest risk so they can take preventative practices. It's not that encountering a tick is going to lead to an infection. There's things that you can do to modify that infection. So for example, if you go to the woods where you know there are going to be ticks, you can take preventative measures before spraying yourself with a tick repellent or spraying your clothes with permethrin.

But then after coming home, you check for ticks right away. And those are things that if you are going into risky environments, you have to be aware of. So there's, depending on where we're talking about the different things that you can do. And I think the tools that we're trying to develop is to give more tools for people to make decisions and to really understand where the risk is so they can prevent and take precautions. Know that if they found a tick on themselves that has been attached for a while, they have to monitor for symptoms and make sure that the medical community is aware that there

might be tick-borne diseases in the region or in the area, and that people with certain signs and symptoms might be worth testing for these diseases. And then you started the conversation with COVID, which obviously is a disease also that came to us from the animal community. How much does overpopulation and climate change increase risk of broader epidemics? And what does the scientific community think about what is the general threat to the population with a new disease like COVID arriving? Yeah, I would say in the last decade, people that are working in my field, disease ecologists, there has been an increase on these emerging diseases coming from animals and jumping into different species. And this is all over what we, that jump from one species to another. From the pathogen perspective, whether it's a virus or bacteria, we're just another

mode to that. What is driving this, there's probably many explanations happening at the same time. So one is obviously there is a climatic effect that it's changing how the animals behave or how the animals use the environment and whether they're able to be present in new environments. But also with humans, with our activities, we're also really getting closer into those environments that maybe in the past we didn't used to do it to this scale. Diseases jumping from animals to humans has always happened in the history of humankind. But to the scale that we're doing it now is definitely accelerating.

And if we get in contact with more natural environments and we're modifying them, the chances that diseases that have been circulating in animals get in contact with humans really increases. And because human density is increasing as well, the chances that an infected human can pass it to another infected human also is higher. You're doing very important work, and I want to thank you for that, because obviously this is a growing challenge in society as we navigate our planet. And thank you for giving some insight in how technology is contributing to your research. Where can people find out more about the studies that you've done and engage if they have specific

interests in this area? Yeah, I would say one of the challenges that we have as scientists is that most of our work goes published in scientific papers and we don't have a lot of outreach. I think one of the things that we've learned with the past pandemic is that it is really important that we get the word out of what we're doing, what is the value of what we're doing. And we're still behind, I would say. If people want to know more, there's definitely all our scientific papers that you can go to, we have a institutional website at WSU and you can look for our papers and find out more from a technical point of view. But we're still trying to work more of how to get this information out to the public and how the public can contribute more.

I would say community science, definitely trying to leverage that as much as we can because as I said, we cannot be everywhere at the same time, but we need data to feed into those models to better understand what is happening. Yes, I would say we're open.

I think most of the scientists are open to hear from the general public and how can we address societal questions that, I don't know, can contribute to the well-being of all, but we're still lagging behind. And how do we actually establish those communication channels? Well, Pilar, I think that this podcast is the one way that you can do that. So thank you so much for sharing your story and what the research community is doing in this space. It was a great education. Thank you so much. Thanks for joining The Tech Arena. Subscribe and engage at our website, thetecharena.net.

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