Fighting COVID-19

New technologies for second wave COVID-19 triage

  • #16557


    The year 2020 should have been the start of an exciting decade in medicine and science, with the development and maturation of several digital technologies that can be applied to tackle major clinical problems and diseases. These digital technologies include the internet of things (IoT) with next-generation telecommunication networks (e.g., 5G), big-data analytics, artificial intelligence (AI) that uses deep learning; and blockchain technology. They are highly inter-related: the proliferation of the IoT (e.g., devices and instruments) in hospitals and clinics facilitates the establishment of a highly interconnected digital ecosystem, enabling real-time data collection at scale, which could then be used by AI and deep learning systems to understand healthcare trends, model risk associations and predict outcomes. This is enhanced by blockchain technology, a back-linked database with cryptographic protocols and a network of distributed computers in different organizations, integrating peer-to-peer networks to ensure that data are copied in multiple physical locations, with modified algorithms to ensure data are secured but traceable6.

    The COVID-19 crisis clearly differs from the SARS epidemic in 2003. Most countries have relied on an extrapolation of classic infection-control and public-health measures to contain the COVID-19 pandemic, similar to those used for SARS in 2003. These range from extreme quarantine measures in China to painstaking detailed contact tracing with hundreds of contact tracers. However, these measures alone may not be effective in 2020 for tackling the scale of COVID-19. The new digital technology must be used for COVID-19: the application of four inter-related digital technologies (the IoT, big-data analytics, AI and blockchain) can augment two traditional public-health strategies for tackling COVID-19: (1) monitoring, surveillance, detection and prevention of COVID-19; and (2) mitigation of the impact to healthcare indirectly related to COVID-19.

    First, the IoT provides a platform that allows public-health agencies access to data for monitoring the COVID-19 pandemic. This platforms provide a real-time update on the actual number of people known to have COVID-19 worldwide, including daily new cases of the disease, disease distribution by countries and severity of disease (recovered, critical condition or death).

    Second, big data also provides opportunities for performing modeling studies of viral activity and for guiding individual country healthcare policymakers to enhance preparation for the outbreak.

    Third, digital technology can enhance public-health education and communication. In Singapore, the government has partnered with WhatsApp (owned by Facebook). Multiple social-media platforms (e.g., Facebook and Twitter) are currently used by healthcare agencies to provide ‘real-time’ updates and clarify uncertainties with the public. Additionally, some facial-recognition companies have adopted the thermal imaging–enabled facial recognition to identify people with an elevated temperature at various screening points.

    Fourth, AI and deep learning can enhance the detection and diagnosis of COVID-19. The need to provide access to accurate and low-cost tests for the diagnosis of COVID-19 is a challenge. Alternative diagnostic and screening tests for COVID-19 will be extremely useful. Many countries now have large datasets of cases positive for COVID-19. These are ideal datasets for deep AI and deep learning. Such AI algorithms can then be used as an initial screening tool for suspected cases (e.g., travel history, or exposure to confirmed cases) so that patients at higher risk could have confirmatory laboratory-based tests or be isolated.

    Although most patients have mild cases of COVID-19, physicians have to apply the same level of intensive methods to isolate, treat and monitor all patients. AI algorithms could be developed to help physicians triage patients with COVID-19 into potentially three groups: the 80% who have mild disease; the 15% who have moderate disease; and the 5% who have severe disease, including those at high risk of mortality. Finally, AI can also facilitate the discovery of novel drugs with which to treat COVID-19.

    Although the focus of tackling the direct impact of COVID-19 is important, in many healthcare settings, it is important to maintain core and critical clinical service. The initial reaction in many countries is for healthcare facilities to reduce or even cease many clinical services, including closure of clinics and postponement of medical appointments or elective surgeries. However, such strategies cannot be sustained indefinitely when the COVID-19 pandemic extends beyond 6 months.

    Healthcare systems are extending the use digital technology. For example, ‘virtual clinics’ could be set up through the use of tele-medicine consultations with imaging data (e.g., chest X-ray and/or CT of the thorax) uploaded from peripheral sites and interpreted remotely. This would ensure that patients continue to receive standard clinical care while reducing physical crowding of patients into hospital premises. For other key hospital activities (e.g., research and education), virtual e-learning platforms are increasingly being explored to eliminate physical meetings.

    Second, the utilization of various AI-based triage systems could potentially alleviate the clinical load of physicians. An online medical ‘chat bot’ could help patients recognize early symptoms, educate people on the importance of hand hygiene and refer people for medical treatment should symptoms worsen. Additionally, phone-based software that detects and records patients’ data (e.g., daily temperature and symptoms) may prevent unnecessary hospital consultations for patients with mild flu-like symptoms. These data could also be developed into AI algorithms for the detection of COVID-19.

    Third, many hospitals are collaborating with blockchain companies and pharmacies to deliver patients’ medication to their doorsteps. Through the use of blockchain, hospitals could ensure timely delivery of medications with accurate tracking.

    In summary, while the world continues to rely on classic public-health measures for tackling the COVID-19 pandemic, in 2020, there is now a wide range of digital technology that can be used to augment and enhance these public-health strategies There is also a longer-term goal. The immediate use and successful application of digital technology to tackle a major, global public-health challenge in 2020 will probably increase the public and governmental acceptance of such technologies for other areas of healthcare, including chronic disease in the future. As the saying goes, ‘a crisis provides an opportunity’; this first great crisis of 2020 provides a great opportunity for digital technology.

    More details at the original publication: Ting, D.S.W., Carin, L., Dzau, V. et al. Digital technology and COVID-19. Nat Med 26, 459–461 (2020).

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