Craig Dalton remembers a moment of doubt among his team who were developing an online flu survey back in 2005.
The public health physician recalls the survey developer pushing himself back in his chair and telling his colleagues he was worried no-one would use it.
It turns out, the fear was unfounded.
The FluTracking survey his team created to help monitor respiratory diseases works in real time by surveying people in the community about their symptoms.
It has been adopted overseas, and in some countries it is one of the main surveillance systems for influenza-like illness and, of course, COVID-like illness.
Its success, in part, lies with the fact that the survey takes less than a minute.
At its inception in 2006, it was being used by about 400 people in the Hunter New England region.
Now, more than 60,000 people across Australia access it each week.
"We didn't know what to expect when we sent the survey out in 2006." Dr Dalton says.
"We didn't know whether we would get five responses, 10 responses, no responses."
During the height of the pandemic, up to 150,000 people a week responded to the survey and their responses gave important insights into the coronavirus crisis.
Importantly, Dr Dalton says the survey showed that standard testing, such as PCR swabs, were not reflective of the true number of active cases in Australia.
"FluTracking showed the actual testing rates weren't high enough to pick up that many cases," he says.
"It gave us a really good reality check on what proportion of cases we were missing."
Survey captures real-time experience
FluTracking was inspired by a 2005 Swedish study of a telephone survey to track trends in the spread and severity of the flu.
The use of the survey — created by physicians with help from the NSW Health Department and the University of Newcastle — has spread to New Zealand, Hong Kong and Argentina.
He says the survey creates a window into what is happening in real time in the community.
"FluTracking plays a special role because it goes directly to people and gets their actual experience on the ground," he says.
Survey translated into Spanish
The push to get FluTracking into Argentina came from Nick Walsh, who worked with the Pan American Health Organization, an arm of the World Health Organization.
Dr Walsh was the regional adviser in communicable and infectious diseases and worked directly with Argentina's health officials.
"When it became apparent that COVID had really escaped Asia and was going to propagate, I immediately reached out to people in ministries of health over in South America," Dr Walsh said.
"We did [a webinar] and we had about 300 people [attend] across Argentina in mid-2020."
The webinar was uploaded online, which later attracted an additional 15,000 viewers.
"They [authorities] really didn't have any weapons [against COVID] in Argentina at the time. Obviously, with a severe wave that went through Argentina, they went to lockdown because they didn't have much option," Dr Walsh said.
At the webinar Dr Dalton introduced FluTracking, which was seen as a high-impact, low-cost option.
With seed funding from Australia's Department of Foreign Affairs and Trade, the team was able set the survey up in Argentina.
"We had to translate it in 2021 into Spanish and we did a soft-launch. We have only been up and running since Omicron, so this is part of the mix in order to track COVID and obviously now flu," he says.
Survey comes at the right time
Dr Walsh says the survey was ahead of its time, being developed for the internet back in the mid-2000s and now being accessible to anyone with a smartphone.
He says he is proud of Australia's role in helping the South American country, and he hopes to strengthen ties between the two countries.
"It [coronavirus] was extremely tough and economically it's had its challenges over there. So for us to be able to contribute something to be able to give them the opportunity to know what's happening, more information, it's been a real privilege," he says.
