How Digital Technology helps us in the Covid-19 pandemic?
With high transmissibility and no effective vaccine or therapy, COVID-19 is now a global pandemic. Government-coordinated efforts across the globe have focused on containment and mitigation, with varying degrees of success. Countries that have maintained low COVID-19 per-capita mortality rates appear to share strategies that include early surveillance, testing, contact tracing, and strict quarantine. The scale of coordination and data management required for effective implementation of these strategies has—in most successful countries—relied on adopting digital technology and integrating it into policy and health care. This Viewpoint provides a framework for the application of digital technologies in pandemic management and response, highlighting ways in which successful countries have adopted these technologies for pandemic planning, surveillance, testing, contact tracing, quarantine, and health care.
Planning and tracking
Big data and artificial intelligence (AI) have helped facilitate COVID-19 preparedness and the tracking of people, and so the spread of infection, in several countries. Tools such as migration maps, which use mobile phones, mobile payment applications, and social media to collect real-time data on the location of people, allowed Chinese authorities to track the movement of people who had visited the Wuhan market, the pandemic’s epicenter.
With these data, machine learning models were developed to forecast the regional transmission dynamics of SARS-CoV-2 and guide border checks and surveillance. This integration allowed health-care facilities to access patients’ travel histories and identify individuals for SARS-CoV-2 testing and tracking.
Screening for infection
Countries use free, web-based, and cloud-based tools to screen and direct individuals to appropriate resources.
High-performance infrared thermal cameras set up in airports are used to capture thermal images of people in real-time, rapidly detecting individuals with a fever.
In Singapore, people have their temperature measured at the entries of workplaces, schools, and public transport. The data from the thermometers is tracked and used to identify emerging hot spots and clusters of infection where testing could be initiated.
Unlike most other countries, Iceland has launched widespread testing of asymptomatic individuals.
Using mobile technology, Iceland collects data on patient-reported symptoms and combines these data with other datasets such as clinical and genomic sequencing data to reveal information about the pathology and spread of the virus.
This approach has added to the knowledge base regarding the prevalence and transmission of asymptomatic COVID-19. To date, Iceland has had the highest per-capita testing rate and among the lowest per-capita COVID-19 mortality rate.
Other countries offering widespread testing include Germany and South Korea. In the USA, a private company has used digital thermometers to collect real-time data on clusters of febrile illness,
and a national study is capturing resting heart rate with a smartwatch application, which could be able to identify COVID-19 emerging outbreaks.
These initiatives are either enterprise-driven or investigational and are not integrated into policy and practice.
Systematic screening technologies are expensive and require trained personnel, restricting their uptake in many countries.
The incubation period and the relatively high prevalence of asymptomatic infection compared with other infectious diseases limits the effectiveness of digital systems that screen vital signs or self-reporting of symptoms.
Some countries have implemented tools for aggressive contact tracing, using security camera footage, facial recognition technology, bank card records, and global positioning system (GPS) data from vehicles and mobile phones to provide real-time data and detailed timelines of people’s travel.
South Koreans receive emergency text alerts about new COVID-19 cases in their region, and people who could have been in contact with infected individuals are instructed to report to testing centers and self-isolate.
By identifying and isolating infections early, South Korea has maintained among the lowest per-capita mortality rates in the world.
Singapore has launched a mobile phone application that exchanges short-distance Bluetooth signals when individuals are in proximity to each other. The application records these encounters and stores them in their respective mobile phones for 21 days. If an individual is diagnosed with COVID-19, Singapore’s Ministry of Health accesses the data to identify contacts of the infected person.
Like South Korea, Singapore has maintained one of the lowest per-capita COVID-19 mortality rates in the world.
Germany has launched a smartwatch application that collects pulse, temperature, and sleep pattern data to screen for signs of a viral illness.
Data from the application are presented on an online, interactive map in which authorities can assess the likelihood of COVID-19 incidence across the nation.
With widespread testing and digital health interventions, Germany has maintained a low per-capita mortality rate, relative to other countries, despite a high prevalence of cases.
Contact tracing applications are not without pitfalls.
Not all exposure requires quarantine, such as when the exposed individuals are wearing personal protective equipment or are separated by thin walls penetrable by mobile phone signals.
On the other hand, relevant exposure could be missed when individuals do not carry their mobile phones or are without mobile service.
In addition, researchers at Oxford University (UK) have suggested that 60% of a country’s population would need to use a contact tracing application for it to be an effective mitigation strategy.
Quarantine and self-isolation
The indiscriminate lockdowns for infection control in several countries have had severe socioeconomic consequences. With digital technology, quarantine can be implemented in individuals who have been exposed to or infected with the virus, with less strict restrictions imposed on other citizens. China’s quick response (QR) code system, in which individuals are required to fill out a symptom survey and record their temperature, allows authorities to monitor health and control movement.
The QR code serves as a COVID-19 health status certificate and travel pass, with color-codes representing low, medium, and high risk; individuals with green codes are permitted to travel unrestricted, whereas individuals with red codes are required to self-isolate for 14 days. China also uses AI-powered surveillance cameras, drone-borne cameras, and portable digital recorders to monitor and restrict the gathering of people in public.
In Australia, international travelers were quarantined in hotels on arrival, with travelers from Wuhan quarantined off the Australian mainland. In the new legislation, individuals breaching quarantine will be forced to wear tracking devices, with fines levied for further instances of breaking the restrictions.
In Taiwan, electronic monitoring of home-quarantined individuals is facilitated through government-issued mobile phones tracked by GPS;
in the event of a breach in quarantine, this so-called digital fence triggers messages to the individual and levies fines.
In South Korea, individuals in self-isolation are instructed to download a mobile phone application that alerts authorities if they leave their place of isolation.
In Hong Kong, people in self-isolation are required to wear a wristband linked through cloud technology to a database that alerts authorities if quarantine is breached.
Iceland has launched a mobile phone solution to monitor individuals with COVID-19 and ensure that they remain in self-isolation.
Mobile phone solutions for quarantine enforcement can be bypassed if individuals leave their quarantine location without their devices.
Self-reported surveys such as those used in QR code systems only work when individuals are symptomatic and report their symptoms accurately.
However, such technological innovations could provide benefits when used in combination with other strategies.
AI can facilitate rapid diagnosis and risk prediction of COVID-19. A cloud-based AI-assisted CT service is used to detect COVID-19 pneumonia cases in China.
This technology processes CT images in seconds, differentiating COVID-19 from other lung diseases and speeding up the diagnostic process substantially.
COVID-Net, an open-source deep convolutional neural network design available to clinicians across the globe, can quickly detect COVID-19 cases from other lung diseases on chest x-rays.
Machine learning algorithms developed in China can predict the likelihood of developing acute respiratory distress syndrome and critical illness among infected patients.
These prediction models can guide clinical decision-making and resource allocation, identifying regions and hospitals in need of critical care resources and medical supplies.
Virtual care platforms, using video conferencing and digital monitoring, have been used worldwide to deliver remote health care to patients as a means of reducing their exposure to SARS-CoV-2 in health-care institutions. In Canada, clinician-to-patient video visits have increased from approximately 1000 visits per day in February 2020, to 14 000 per day by mid-May.
Countries such as the USA and Australia have also harnessed digital technology to provide remote care to patients with chronic conditions or with mild or moderate COVID-19 illness in their homes.
If implemented and delivered appropriately, virtual care can increase health-care access during the pandemic and after, but possible risks could include misdiagnoses, equipment malfunction, privacy breaches, and costs to the health-care system.
Risks of digital technology
Digital health initiatives can amplify socioeconomic inequalities and contribute to health-care disparities. Digital technology typically involves the use of the internet and mobile phones. Although 4 billion people used the internet worldwide in 2019, usage was disproportionally higher in high-income areas than in low-income and middle-income areas (82% in Europe vs 28% in Africa).
Even within high-income countries, susceptible groups, such as those in low-income neighborhoods or remote regions, might not have access to broadband signals, smartphones, or wearable technology such as smartwatches. To effectively implement digital technology globally, interventions should be tailored to the target regions; broadband access requires federal and private sector investment in technology and infrastructure.
At a regional level, subsidized mobile phone plans, loaner devices, free Wi-Fi hotspots, and training programs could provide temporary solutions to these disparities.
In regions without infrastructure or sufficient funds to support cellular and data coverage, automated applications, and devices that do not require continuous network access should be considered.
Several digital health interventions, particularly those that track individuals and enforce quarantine, can infringe on privacy while increasing risk among individuals with mental illness or restricted access to food or water. Government-implemented surveillance and control can instill fear and threaten civil liberties. To balance the need for contact tracing and privacy, European authorities have proposed that data be retained for only 14 days, the period of possible viral transmission and that non-essential digital measures be lifted once the pandemic ends.
Some European countries are deploying an opt-in smartphone tracking application with anonymized data, no central database, and no GPS information.
The appropriate concerns about privacy and data security are potentially offset by facilitating a return to a normal routine without a rebound in infections.
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