Indian Journal of Public Health

REVIEW ARTICLE
Year
: 2020  |  Volume : 64  |  Issue : 6  |  Page : 117--124

The global experience of digital health interventions in COVID-19 management


Sohini Sarbadhikari1, Suptendra Nath Sarbadhikari2,  
1 B. Tech. Student, Department of Biomedical Engineering, Manipal Institute of Technology, Manipal, Karnataka, India
2 Former Dean Academics and Professor in Health Informatics, IIHMR; Former Project Director, Centre for Health Informatics, National Health Portal, NIHFW, New Delhi, India

Correspondence Address:
Suptendra Nath Sarbadhikari
2501 Lords Apartment, Plot 7, Sector 19b, Dwarka, New Delhi - 110 075
India

Abstract

Digital health interventions are globally playing a significant role to combat coronavirus disease 2019 (COVID-19), which is an infectious disease caused by Severe Acute Respiratory Syndrome coronavirus 2. Here, we present a very brief overview of the multifaceted digital interventions, globally, and in India, for maintaining health and health-care delivery, in the context of the Covid-19 pandemic.



How to cite this article:
Sarbadhikari S, Sarbadhikari SN. The global experience of digital health interventions in COVID-19 management.Indian J Public Health 2020;64:117-124


How to cite this URL:
Sarbadhikari S, Sarbadhikari SN. The global experience of digital health interventions in COVID-19 management. Indian J Public Health [serial online] 2020 [cited 2021 May 11 ];64:117-124
Available from: https://www.ijph.in/text.asp?2020/64/6/117/285593


Full Text



 Introduction



Coronavirus disease 2019 (COVID-19), is the infectious disease caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). This new virus and the disease caused by it were unknown before the outbreak began in Wuhan, China, in December 2019. COVID-19 is one of the most contagious diseases to have hit us in decades. As governments and health organizations scramble to contain the spread of coronavirus, they need all the help they can get, including from artificial intelligence (AI). Although current AI technologies are far from replicating human intelligence, they are proving to be very helpful in tracking the outbreak, diagnosing patients, disinfecting areas, and speeding up the process of finding a cure for COVID-19.[1],[2],[3],[4],[5]

The objectives of the global surveillance[5] for human infection with COVID-19 are:

To monitor trends of the disease where human to human transmission occurs;Rapidly detect new cases in countries where the virus is not circulating;Provide epidemiological information to conduct risk assessments at the national, regional, and global level; andProvide epidemiological information to guide preparedness and response measures.

While a lot of work is going on in the domains of public health, as well as clinical and laboratory domains, this commentary is trying to focus on some of the global efforts in utilizing digital health tools and interventions to fight the COVID 19 pandemic. In this digital age, it is also necessary to be aware of the so-called “infodemic” whereby a lot of misinformation is also being spread through social media.[6]

Digital health is being defined[7] as “the field of knowledge and practice, associated with any aspect of adopting digital technologies to improve healthcare, from inception to operation.” In this commentary, we try to highlight some of the global digital health interventions that have affected and are affecting, noticeably, toward combating Covid-19. Digital Health[8] has been envisaged as a pillar for the National Health Policy-2017.

 Primary Prevention



Mobile applications or mApps have been used primarily for contact tracing – tracking persons and notifying the authorities, using Bluetooth. Some of the notable examples[9] include TraceTogether (Singapore), CovidWatch (USA), PeduliLindungi (Indonesia), Kwarantana Dommowa (Poland), HaMagen (Israel). In India, we have Aarogya Setu,[10],[11] which can detect other nearby smartphones that also have the app installed. It can then figure out the risk of infection based on sophisticated parameters if any of these contacts is tested positive. The basis of this calculation – which is done using Bluetooth, algorithms, and AI – is the smartphone user's interaction with others with ePass features being added.[12] Already more than 100 million or 10 crores of download has occurred.

A chatbot (short form for chat-robot) is a software application (most often powered by AI) that can carry out online chat conversation through text or text-to-speech, instead of conversing directly with a live human being. Some of the noteworthy chatbots[13],[14],[15],[16] are from CDC, WHO, Google, IBM Watson.

AI-based chatbot ZINI[17] helps users get answers to their queries about Covid-19 and analyze the risk of infection with respect to its symptoms in India.

 Health Education and Promotion Using Digital Platforms



Google Trends and Maps, Twitter and Instagram feeds, Tiktok videos have been used even by agencies like the CDC and WHO to track the progress of the diseases and also to spread awareness related to its precautions.[18],[19],[20],[21],[22],[23]

Callertunes[24] have been used by the Ministry of Health and Family Welfare, Government of India, to raise awareness about COVID 19, and also to maintain hygiene through hand washing. Digital media campaigns[25] have also been encouraged by the government and run by the corporates, alerting everyone to “Stay Home, Stay Safe.”

Various websites and portals of the Government of India (All India Institute of Medical Sciences [AIIMS],[26] MoHFW,[27] ICMR[28]) are providing updated resources, guidelines, and dashboards for education and awareness related to COVID 19.

 Early Diagnosis



Data visualization is an important tool for exploring and communicating findings and plays an important role in epidemic/pandemic time series analysis and forecasting. Many tools,[2],[5] including dashboards, have been developed for visualizing temporal data and recommending course(s) of action. Research enabled Action-oriented Policy Interventions driven by Data tracker[29] is an interactive policy informatics platform tracking spread of COVID-19 outbreak and policy actions globally. The WHO has created a repository of about >5000 peer-reviewed and curated research articles on varied aspects, including epidemiology, clinical features, diagnosis, treatment, social factors, and economics. By applying the AI technique of Natural Language Processing, developed by researchers at IIIT Delhi,[30] on this massive literature, it is now possible to discover the direct effects of COVID-19 and also the systematic implications such as the anticipated rise in TB and cancer mortality due to the nonavailability of drugs during the export lockdown as highlighted by the models. This is a good example where users understand, synthesize, and take pre-emptive action with the available peer-reviewed evidence on COVID-19.

Bluedot has developed an outbreak risk software[31] that can help in handling exposure and spread of infectious diseases like Covid-19. Bluedot helps answer pressing questions regarding the report of local cases in various countries and its severity. They provide real-time insights to users with Covid-19's movements, strengthening the security of human health.

Researchers at Yale University have developed a model[32] for the spread of the epidemic where the first 50 days of Covid-19 in China is measured by the impact of transmission control. They evaluated the spread and control of the disease from synthesized data that was collected digitally, consisting of case reports, human movement, and public health interventions. It was concluded that the cities that implemented control measures at an early stage reported lower cases in the 1st week compared to the cities that started to take control later.

In the diagnostic arena, ICMR has approved a Probe-free COVID-19 detection assay, developed by researchers from IIT Delhi.[33] This is a real-time polymerase chain reaction based diagnostic assay with 100% specificity and sensitivity.

 Treatment



Conventionally, when dangerous new bacterial and viral infections emerge, the response is to develop a treatment that combines several different drugs. However, this process is laborious and time-consuming, with drug combinations chosen sub-optimally, and the selection of doses is a matter of trial and error. This costly and inefficient way of developing treatment is problematic when a rapid response is crucial to tackle a global pandemic, and resources need to be conserved. With this in mind, Professor Dean Ho, of NUS Biomedical Engineering, led a multidisciplinary team[34] of researchers to come up with a pioneering AI platform known as “IDentif. AI” (Identifying Infectious Disease Combination Therapy with AI) to dramatically increase the efficiency of this development.

BenevolentAI, a startup[35] which has raised $292 million to apply AI to create drugs faster, today says it has uncovered an already approved drug as a potential treatment for COVID-19 after it applied its AI platform and team to the problem. The revelation, which has now appeared in peer-reviewed scientific journals and has entered clinical trials with a major pharmaceutical company, could offer a glimmer of hope to a world locked down by the pandemic. In February, BenevolentAI set up a specialist scientific team and launched an investigation using its drug discovery platform.

Israeli AI company Medial EarlySIgn has been able to flag[36] high-risk COVID-19 patients, for fast track testing.

 Role of Telehealth in Care of Covid and Non-Covid Illnesses



In the USA,[37] telehealth has played a significant role in transforming health-care delivery during the three phases of the US COVID-19 pandemic: (1) Stay-at-Home Outpatient Care; (2) Initial COVID-19 Hospital Surge, and (3) Post-Pandemic Recovery.

In China,[38] five focal themes were identified across the webpages published by the hospitals during January 22 to February 21, 2020, including (1) popular medical science education, (2) digitalized hospital processes, (3) knowledge management for medical professionals, (4) telemedicine, and (5) new IT initiatives for health-care services. The researchers found that Chinese hospitals spent greater effort in promoting popular medical science education in the initial stages of the study period and more on telemedicine in the latter stages.

In a very timely intervention, India has released the Telemedicine Practice Guidelines 2020 for modern medicine[39] AYUSH (Ayurveda, Unani, and Siddha)[40] and Homoeopathy.[41]

The Union Minister of Health and Family Welfare (MoHFW) Dr. Harsh Vardhan launched the National Teleconsultation Centre (CoNTeC)[42] on March 28th, 2020 and also interacted with Nodal Officers of Medical Colleges of States and other AIIMS of the country and reviewed the COVID-19 preparedness. The project CoNTeC, an acronym for COVID-19 National Teleconsultation Centre, has been conceptualized by the MoHFW and has been implemented by the AIIMS, New Delhi. The Health and Wellness Centres, under the Ayushman Bharat scheme, will also be having telehealth services through eSanjeevani.[43]

Globally, an excellent example is the Israeli TeleICU solution CLEW-ICU[44] that uses AI based predictive analytics to exponentially expand ICU capacity and resources. Its algorithms are trained to identify respiratory deterioration in advance, enabling early interventions that might change the clinical outcome, especially in COVID-19 patients. This allows health-care workers to identify disease severity from a remote command center. The field units will use telemedicine technologies to provide remote patient monitoring from centralized command and control facilities.

 Technology Applications Spanning Across All Levels of Prevention



AI[45] and Digital Health,[46] both these terms have been used in multiple contexts for the fight against Covid-19 pandemic, described both above and below. Gamification[47] has been an upcoming concept for healthcare. For exchanging digital health information, standards are essential, especially to have an unambiguous vocabulary. Covid-19 has led to quick solutions[48] in this area too.

All the Indian Institutes of Technology have[49] started vital, innovative work that extends from different perspectives. This includes PPE's, production of three-layered surgical masks and high-efficiency face masks (N95), antimicrobial fabric development, SARS CoV2 detection assay, preparation of sanitizer, designing low-cost ventilators and screening inhibitors for nCoV-19 structural proteins vis-à-vis creating virus-like particles for vaccine development.

In the countries that are effectively using technology for contact tracing, the first step — and a requirement – is to encourage, or, better yet, mandate the installation of tracking apps on phones. In East Asian countries,[50] this has been more mandatory than voluntary.

An example of Remote Healthcare is a Virtual hospital-like Mercy Virtual Hospital[51] that has opened a Covid-19 test collection site in St. Louis, where patients only meeting with Covid-19 criteria are tested. Mercy provides with a drive-through Covid-19 test collection site. Patients are first required to call Mercy's clinical support line to be screened and if the symptoms are found to be appropriate, the patient shall proceed to the test collection site where Mercy will collect the patient sample and send it to the designated lab for further testing.

Robots and Drones are being used globally to combat COVID 19. The first person diagnosed with Covid-19 in the United States[52] was treated majorly by a robot equipped with a stethoscope that helped the doctors take the patient's vitals and communicated via a large screen in Seattle. This way, the patient was kept in isolation and could still be treated without further spread of the disease. UNIDO's investment and technology promotion office (ITPO) in Shanghai and White Rhino Auto Company in Beijing partnered[53] to set to work at Wuhan's Guanggu Field Hospital by bringing two White Rhino unmanned vehicles to transport medical supplies, deliver meals for patients and doctors and help carry out other emergency tasks in the hospital. The usage of unmanned vehicles helped decrease the chance of infection as well as reduce the workload of the medical staff. Another ITPO Shanghai partner CloudMinds tech company worked with Wuhan Wuchang Hospital and China Mobile to start a field hospital named “smart field hospital” staffed by robots. Their intention being to gauge the effectiveness of using robots to relieve exhausted health-care service providers.

In India, AIIMS, New Delhi, has deployed Milagrow robots[54] to contain the spread of COVID-19. Milagrow iMap9 is a floor disinfecting robot that navigates and sanitizes floor without human interference, while Milagrow humanoid elf allows doctors to monitor and interact with infected patients. The government hospital in Tiruchirappalli[55] has four functioning robots that will lend a hand to the health-care professionals dealing with contagious patients.

A drone technology[56] allows to scan through a crowd of people and detect someone in need for medical attention, transports medical samples, and disinfects using the aerial spray. MicroMultiCopter, a drone[57] startup based in Shenzen, has dispatched around 100 drones that use AI and facial recognition to monitor citizens in real-time across China. In Singapore, NParks has introduced[58] the SafeDistance@Parks portal to enable the public to check visitorship levels at major parks and gardens to help choose the less crowded area. Thirty drones are currently being used that assist with the high vantage point to access visitorship updates rapidly, complementing ground observations.

Drones have been deployed across New Delhi[59] to warn people against breaching restrictions of the national lockdown and to ensure no supply disruption of essential requirements.

Video games in recent times use HPC (High-performance computing) that helps turn a large amount of data into visual pictures. GPU (Graphics processing unit) accelerates these graphic tasks to render images.[60] These GPUs are usually attached to CPUs (Central processing unit) of the computer to create video display. This technology helps in (virus) protein three-dimensional (3D) reconstruction and similarity searching. The use of GPUs has helped immensely in reconstructing the structure of the coronavirus protein.

Crowdsourcing is the practice of obtaining information or input (goods and services, including ideas, voting, micro-tasks, and finances) into a task or project, by enlisting the services of a large, relatively open and often rapidly-evolving group of people, either paid or unpaid, typically via the Internet. Below, some of the notable examples are given.

Researchers at Harvard Medical School and Boston Children's Hospital[61] have launched a new website named 'COVID Near You' that allows the public to report current symptoms in real-time which will be identified only by ZIP code and the tool was developed by HealthMap team at Harvard medical school and Boston Children's Hospital. This website helps experts track locations and the rate of spreading or receding.

National Aeronautics and Space Administration (NASA) has been utilizing its crowdsourcing platform NASA@WORK[62] to collect creative ideas on ways to tackle the COVID-19 crisis. They have identified and focused more on the need to work on ventilation hardware, protective equipment, monitoring, and tracking the spread and transmission of the pandemic, expecting functioning submissions from the staff, which will be made an open-source once proven to have successful results.

The MIDAS Coordination Centre has launched an online portal[63] for COVID-19 modeling research that helps navigating and searching for COVID-19 related information while the COVID-19 GitHub repository is used for sharing computable files with data, parameter estimation and software.

American Medical Association, along with Folding@home[60] has requested the general public to donate their unused GPU and CPU computing power to battle against COVID-19 on Reddit.

A series of challenges exclusively related to Covid-19 has been initiated by InnoCentive and Wazoku[64] that include topics such as prevention technology, protective films, treatment, diminishing transmission, ventilation systems, and much more. Clients from public and/or private sectors are to be named in the challenges as having provided support.

Indian Government agencies[65] like the Department of Biotechnology, Council for Scientific and Industrial Research, the Ministry of Electronics and Information Technology, as well as the Department of Science and Technology have already launched several programs to spread awareness and find ways to tackle the virus. They have been crowdsourcing ideas and solutions from experts, companies, academia, and citizens to tackle the spread of the Covid-19 virus in India. An “S&T core team” has been set up in the office of the Principal Scientific Advisor to look at these ideas and collaborate with labs and industry to take those solutions faster to the public.

MyGov Innovation COVID-19 Solution Challenge:[66] The Government of India has taken steps to involve the public community (crowdsourcing) in battling against the virus by initiating the COVID-19 solution challenge where the general public will have the chance to put up their solutions, and the submitted information will be evaluated for adoption. The solutions with a fruitful result will be selected and suitably rewarded.

Samadhan: The Innovation Cell of the Ministry of Human Resources Development[67] has released another online (crowdsourcing) challenge “Samadhan” to invite creative ideas to reduce the spread of the coronavirus, which is categorized into two parts namely Track 1 and Track 2. Track 1 is for student innovators, researchers, educators, and startups to share their ideas through YouTube video links, whereas Track 2 invites people with a working prototype of technologically advanced solutions which can be validated and deployed instantly. The Innovation Cell requires the participants to tweet once the idea is submitted.

The Indian Department of Science and Technology has come up with a list[68] of nearly 30 innovative technologies on COVID-19 from Israeli companies. The ministry has also sought interest from Indian researchers and companies in this regard.

3D printing (or additive manufacturing) process builds a 3D solid object from a computer-aided design model, usually by successively adding material layer by layer. It has been utilized in multifarious ways to tackle COVID 19 pandemic. Some examples follow.

Valve: Snorkeling masks[69] were dismantled and studied with the addition of slight changes. A new component was designed and 3D-printed, which was named the “Charlotte valve” that connected the mask to a ventilator. The prototype was tested in Chiari hospital and proved to be successful.

Mask: Copper 3D, a manufacturer of 3D printing materials, has published an open-source STL digital file on an N-95 mask[70] that could be 3D printed and claims that its NanoHack 3D printed mask is antimicrobial, antiviral, recyclable and reusable which includes a modular fine particle filtration system with copper nanocomposite which apparently deactivates viruses.

Door openers: Materialise, a 3D designing and printing company, has come up with free design files for the world to access and 3D print hands-free door openers[71] to help decrease the spread of the virus.

The Internet of things (IoT) is a system of interrelated computing devices, mechanical and digital machines provided with unique identifiers. They have the ability to transfer data over a computer network without requiring human-to-human or human-to-computer interaction. A good example is a smartwatch app[72] launched by Germany's public health authority in partnership with health tech startup Thryve to monitor the spread of Covid-19 and analyze the functionality of the measures to control the pandemic. This app gathers vital signs, including pulse, temperature, and sleep of the user that helps in detecting the symptoms of the illness. IoT technology[73] is capable of providing a personalized experience in the room for customers. Guests will be able to interact with room service and the reception desk using voice assistants placed in the rooms in some smart hotels in the Netherlands. TV, AC, curtains, and lights can be operated using voice commands allowing to get access to a touchless experience. Such measures could be extremely useful during the COVID-19 pandemic.

Wearables:Wearable technology or wearable devices or simply wearables, (a subset of IoTs) are smart electronic devices (electronic device with microcontrollers) that are worn close to and/or on the surface of the skin, where they detect, analyze, and transmit information of various body signals like vital signs. Some of the noteworthy wearables[74],[75],[76],[77],[78],[79] are Fitbit, Project SAFE@HOME, Bahrain's electronic wristband, Estimote's “Proof of Health,” 360 degree solution, and CovidBand+.

 Regulatory Issues Including Data Confidentiality and Privacy



The Personal Data Protection Bill, 2019, is currently being examined by a Joint Parliamentary Committee[80] that is studying the legislation, which was tabled in Parliament late last year. The issues pertain to the inclusion of nonpersonal data in the Bill, exemptions that the government has granted for itself, voluntary verification of users by social media companies, and weakening of the Data Protection Authority. Once the JPC modifies the bill, as deemed fit, it is likely to be passed by the Parliament of India and will be applicable to all the aspects of privacy, security, and confidentiality of any digital data from any domain, including healthcare.

 Pro's and Con's



Just like anything, there would be both pluses and minuses for digital health interventions.

Con's include complicated and complex health information causing concerns for the patients and health-care providers. There could be a reduction in the rapport between the patient and the health-care provider. Digital security and costs can also be some of the barriers and challenges.

However, the pro's outweigh the above. In Digital Health, patients get quicker access to their test results and they can share the information with their family members. The patient has a better and quicker approach along with access to the medical records. Most often, Instructions and Information are simple and easy to document. It also offers clinicians' notes feedback and the patient can review information for medical errors. Thereby, it can be a tool for health protection. It is also easy to pay the bills for the respective services.

 Way Forward



As evident throughout the commentary, digital health is very likely to be expedited by Covid-19, as a major tool for maintaining health and health-care delivery across the world. Many of the advantages, of digital health, mentioned above, cannot be achieved without those digital interventions. It is the right time to empower ourselves better with digital health armamentarium to combat diseases and improve health.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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