Battling a pandemic as serious as COVID-19 requires drastic responses, and political leaders and public-health officials have turned to some of the most radical strategies available. What began with a lockdown of one city in China quickly expanded to the quarantine of an entire province, and now entire countries including Italy. While social isolation and curfews are among the most effective ways to break the chain of viral transmission, some health experts say it’s possible these draconian measures didn’t have to become a global phenomenon. “If health officials could have taken action earlier and contained the outbreak in Wuhan, where the first cases were reported, the global clampdown could have been at a much more local level,” says Richard Kuhn, a virologist and professor of science at -Purdue University.
The key to early response lies in looking beyond centuries-old strategies and incorporating methods that are familiar to nearly every industry from banking to retail to manufacturing, but that are still slow to be adopted in public health. Smartphone apps, data analytics and artificial intelligence all make finding and treating people with an infectious disease far more efficient than ever before.
“The connectivity we have today gives us ammunition to fight this pandemic in ways we never previously thought possible,” says Alain Labrique, director of the Johns Hopkins University Global -mHealth Initiative. And yet, to date, the global public–health response to COVID-19 has only scratched the surface of what these new containment tools offer. Building on them will be critical for ensuring that the next outbreak never gets the chance to explode from epidemic to global pandemic.
Consider how doctors currently detect new cases of COVID-19. Many people who develop the hallmark symptoms of the -disease—fever, cough and shortness of breath—-physically visit a primary-care doctor, a health care provider at an urgent-care center or an emergency room. But that’s the last thing people potentially infected with a highly contagious disease should do. Instead, health officials are urging them to connect remotely via an app to a doctor who can triage their symptoms while they’re still at home.
“The reality is that clinical brick-and-mortar medicine is rife with the possibility of virus exposure,” says Dr. Jonathan Wiesen, founder and chief medical officer of MediOrbis, a telehealth company. “The system we have in place is one in which everyone who is at risk is potentially transmitting infection. That is petrifying.” Instead, people could call a telemedicine center and describe their symptoms to a doctor who can then determine whether they need COVID-19 -testing—without exposing anyone else.
In Singapore, more than a million people have used a popular telehealth app called -MaNaDr, founded by family physician Dr. Siaw Tung Yeng, for virtual visits; 20% of the physicians in the island country offer some level of service via the app. In an effort to control escalating cases of coronavirus there, people with symptoms are getting prescreened by physicians on MaNaDr and advised to stay home if they don’t need intensive care. Patients then check in with their telehealth doctor every evening and report if their fever persists, if they have shortness of breath or if they are feeling worse. If they are getting sicker, the doctor orders an ambulance to take those people to the hospital. Siaw says the virtual monitoring makes people more comfortable about staying at home, where many cases can be treated, instead of flooding hospitals and doctors’ offices, straining limited resources and potentially making others sick. “This allows us to care across distance, monitor patients across distance and assess their progression across distance,” says Siaw. “There is no better time for remote care monitoring of our patients than now.”
Other at-home devices and services currently being used in the U.S. allow patients to measure dozens of health metrics like temperature, blood pressure and blood sugar several times a day, and the results are automatically stored on the cloud, from which doctors get alerts if the readings are abnormal.
Telemedicine also serves as a powerful communication tool for keeping hundreds of thousands of people in a specific region up to date with the latest advice about the risk in their communities and how best to protect themselves. That can go a long way toward reassuring people and preventing panic and runs on health centers and hospitals.
Beyond individual-level care, the data gathered by telemedicine services can be mined to predict the broader ebb and flow of an epidemic’s trajectory in a population. In the U.S., Kaiser Permanente’s tele-medicine call centers are now also serving as a bellwether for an anticipated surge in demand for health services. Dr. Stephen Parodi, national infectious–disease leader at Kaiser Permanente, was inspired by a Google project from a few years ago in which the company created an algorithm of users’ flu–related search terms to determine where clusters of cases were mounting. Parodi started tracking coronavirus–related calls from the health system’s 4.5 -million members in Northern California in February. “We went from 200 calls a day to 3,500 calls a day about symptoms of COVID-19, which was an early indicator of community–based transmission,” he says. “Our call volume was telling us several weeks before the country would have all of its testing online that we have got to plan for a surge in cases.”
On the basis of the swell in calls nationwide, the hospital system is considering suspending elective surgeries based on local circumstances, in part to ensure that ventilators and other critical equipment would be available for an anticipated influx of COVID-19 patients with severe symptoms. Kaiser doctors also postponed appointments for routine mammograms and other cancer–screening tests and cut back on in-person appointments by turning most noncritical visits into virtual visits.
The COVID-19 pandemic may be the trial by fire that telemedicine finally needs to prove its worth, especially in the U.S. Despite the fact that apps and technology for virtual health visits have existed for several decades, uptake in the country has been slow. Medicare only recently began reimbursing for telemedicine visits at rates comparable to in-person visits, and states have just begun to relax licensing regulations that prevent doctors in one state from -remotely treating patients in another state. “This -pandemic is almost like us crossing the Rubicon,” says Wiesen of MediOrbis. “It’s a clarion call for America and for the world on how important telemedicine is.” Parodi agrees. “I think this pandemic will bring in a fundamental change in the way we practice medicine and in the way the health care system functions in the U.S.,” he says. “We’re going to come out of this and -realize a lot of health care visits don’t have to be in person.”
Other tech innovations that haven’t fully made their way to the public-health sector could also play a critical role in controlling this -pandemic—and future outbreaks. Taking a closer look at health-related data, such as electronic health records or sales of over-the-counter medications, can provide valuable clues about how an infectious disease like COVID-19 is moving through a population. Retail drugstores track inventory and sales of nonprescription fever reducers, for example, and any trends in those data might serve as an early, albeit crude, harbinger of growing spread of disease in a community. And given the proliferation of health–tracking apps on smartphones, analyzing data trends like a rise in average body temperature in a given geographical area could provide clues to emerging clusters of cases.
Geotracking on phones, while controversial because of privacy issues, can also streamline the tedious task of contact tracing, in which scientists try to manually trace infected patients’ whereabouts to find as many people with whom they had direct contact and who could have been infected. In South Korea, this strategy helped identify many of the contacts of members of a Seoul church that formed the first major cluster of infections in the country. In countries with a less robust health care infrastructure, smartphones can be critical for gathering information about emerging infections on the ground. In Bangladesh, says Labrique, programs created to canvass for noncommunicable diseases like hyper-tension and diabetes are now being modified to include questions about COVID-19 symptoms. These types of real-time data can rapidly provide a snapshot of where and how fast the disease might be spreading, to distribute health care workers and -equipment where they’re needed most.
It’s all about catching these cases as early as possible, to minimize the peak of a pandemic so the health system doesn’t get overwhelmed. But it’s not just about seeing the trends. Flattening the surge of an infectious disease also requires action, and that’s where the advice gets -muddier—but also where Big Data and artificial intelligence (AI) can provide clarity.
By deeply analyzing the care that every COVID-19 patient receives, for example, AI can tease out the best treatment strategies. Jvion, a health care analytics company, is using AI to study 30 million patients in its data universe to identify people and communities at highest risk of COVID-19 on the basis of more than 5,000 variables that include not just medical history but also lifestyle and socioeconomic factors such as access to stable housing and transportation. Working with clients that include large hospital systems as well as small remote health centers, Jvion’s platform creates lists of people who should be contacted pro-actively to warn them about their vulnerability so health providers can create a care plan for them.
In the case of COVID-19, that might include social distancing and avoiding large public gatherings. To help public-health departments better prepare communities for this and future outbreaks, the company has communicated with the U.S. Centers for Disease Control and Prevention to share what it has learned.
Privacy issues, however, nest in every single byte of data about a person’s health. So the power of AI methods in controlling outbreaks depends on how effectively data can be anonymized. Only when people are assured of privacy can algorithms help to navigate the next big hurdle: predicting surges in cases that strain health care personnel and availability of supplies like ventilators, masks and gowns.
If COVID-19 teaches public-health officials one thing, it’s that there are now tools available to help contain an infectious disease before radical measures like quarantines and curfews are needed. “What we were doing 10 years ago and what we are doing now is vastly different,” says Wiesen. “There is a tremendous opportunity here, and hopefully by [the next pandemic], the use of technology and data analytics is going to be light-years ahead of where it is today.”
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