Chapter 24 Quiz: Epidemiological Surveillance

Instructions: Choose the best answer for multiple choice questions. For short-answer questions, write 2–4 sentences unless otherwise specified.

1. The chapter defines epidemiological surveillance as distinct from clinical medicine primarily because:

a) Epidemiology uses more advanced statistical techniques than clinical medicine b) Epidemiology is government-funded while clinical medicine is private c) Epidemiology focuses on populations and patterns rather than individual patients d) Epidemiology focuses on prevention rather than treatment

2. John Snow's 1854 cholera investigation in Soho is considered foundational to epidemiology because it:

a) Disproved the miasma theory through laboratory analysis of water samples from the Broad Street pump b) Used systematic individual-level data collection and spatial analysis to identify a contaminated water source c) Established the first mandatory disease reporting system in London d) Developed the first disease surveillance database with follow-up of individual cases over time

3. In the NNDSS data flow, what typically happens to patient name and address before data is transmitted to the CDC national database?

a) It is encrypted and transmitted in a format that only the CDC can decrypt b) It is retained at the state level but stripped from the data before transmission to CDC c) It is included in the CDC database but access is restricted to authorized public health officials d) It is required to be deleted within 30 days of the initial state-level report

4. Syndromic surveillance differs from traditional notifiable disease reporting primarily because:

a) It tracks symptoms and proxies before clinical diagnosis, attempting earlier outbreak detection b) It is operated exclusively by private companies rather than government health agencies c) It requires patient consent while traditional reporting does not d) It focuses exclusively on foodborne and waterborne illnesses

5. HIPAA's privacy protections for health information specifically:

a) Prohibit all disclosure of health information without explicit patient consent b) Apply equally to all health information regardless of who holds it c) Permit disclosure for public health reporting, which is an explicit exception to general privacy protections d) Require patients to be individually notified each time their information is shared with a public health authority

6. The Apple/Google COVID-19 Exposure Notification (EN) system was architecturally distinctive because:

a) It required government approval before any exposure notification was sent to a user b) It used GPS location data that was aggregated at the national level before any notifications were generated c) It used rotating Bluetooth identifiers stored locally, never transmitting individual contact records to any server d) It was the first contact tracing system to work automatically without any required user action

7. The chapter identifies which concern with Google and Apple's COVID-19 mobility data?

a) The data was not accurate enough to detect meaningful changes in population movement b) The data was collected for commercial purposes, not for public health, and the aggregation methodology could not be independently verified c) Only smartphone users were captured, creating a significant bias toward younger, wealthier populations d) The data was shared with law enforcement agencies in violation of Google's and Apple's privacy policies

8. "Broad consent" in biobank research means that participants agree to:

a) Research only within the specific diseases listed on their consent form b) Future research that cannot be specified in advance, covering broad health and biology topics c) Researchers contacting them before any specific study begins to seek study-specific consent d) Genetic testing only, with separate consent required for any non-genetic research uses

9. The re-identification risk of genetic data is distinctive because:

a) Genetic data can be matched to individuals even from aggregate statistics, due to its unique individual specificity b) Genetic databases are not covered by HIPAA and can be freely accessed by insurance companies c) Genetic data contains information about future health conditions that makes it more sensitive than other health data d) The technology to extract genetic information from databases is only available to law enforcement

10. "Third-party genetic exposure" refers to the phenomenon that:

a) Your genetic data can be accessed by third parties like insurance companies without your consent b) When you contribute your genetic data, you simultaneously reveal information about relatives who did not consent c) Genetic testing companies can share your data with pharmaceutical companies as a third-party use d) Government agencies can access genetic databases held by research institutions as third parties to the consent agreement

11. The chapter's discussion of wastewater surveillance describes its primary public health advantage over traditional clinical surveillance as:

a) Lower cost than testing individuals b) Early detection: viral RNA appears in wastewater 4-10 days before clinical case surges c) Coverage of populations without health insurance who otherwise avoid testing d) Elimination of the need for laboratory confirmation of clinical diagnoses

12. The chapter identifies chilling effects on health-seeking behavior as a consequence of epidemiological surveillance. Which of the following is a documented example of this?

a) Fear of data breaches deters general practitioners from using electronic health records b) Fear that HIV test results would be disclosed to employers and authorities deterred many people from testing in the epidemic's early years c) Fear of insurance discrimination prevents cancer patients from participating in clinical trials d) Fear of government data collection has caused a measurable decline in emergency room visits

13. Jordan's discomfort during the contact tracing interview — not fully describing attendance at Yara's protest — illustrates which concept from the chapter?

a) Mandatory reporting requirements can deter people from seeking healthcare b) Public health surveillance can create a chilling effect on political activity and free association c) Contact tracers routinely report political information to law enforcement d) Incomplete disclosure during contact tracing interviews is the primary source of error in epidemiological data

14. The HIV surveillance debate described in the chapter involved advocacy groups initially opposing name-based reporting because:

a) They believed that anonymous testing was scientifically equivalent to named reporting b) They feared that government lists of HIV-positive individuals could enable discrimination and persecution c) They objected to mandatory reporting on First Amendment grounds, arguing it violated medical confidentiality d) They had evidence that name-based reporting systems had been breached in previous epidemic responses

15. South Korea's COVID-19 contact tracing approach was architecturally different from Apple/Google's EN system because:

a) South Korea required quarantine hotels rather than home isolation for positive cases b) South Korea used government-developed apps that collected GPS location data and stored it centrally c) South Korea used only paper-based contact records submitted voluntarily by positive cases d) South Korea's system was developed by Samsung rather than by the Korean government

16. Which of the following is NOT identified in the chapter as a key element of "trustworthy epidemiological surveillance"?

a) Minimum necessary collection b) Absolute prohibition on any law enforcement access to health data c) Proportional retention periods d) Community engagement in surveillance program design

17. Short Answer: The chapter describes the "epidemiological paradox" — that epidemiology needs individual data to understand population patterns, but its purpose is population understanding rather than individual surveillance. In your own words, explain this paradox and describe one specific governance mechanism that attempts to manage the tension it creates.

18. Essay (300 words): The COVID-19 pandemic generated an unprecedented expansion of epidemiological surveillance infrastructure — contact tracing apps, wastewater monitoring, mobility data analysis, and expanded mandatory reporting. Write an essay that: (1) identifies two specific examples of this expansion and the governance concerns they raise; (2) argues whether the emergency justification for these expansions was sufficient; and (3) proposes what should happen to each of these surveillance tools now that the acute pandemic emergency has passed.

Answer Key available in Appendix B — Answers to Selected Exercises.