Global Preparedness Against COVID-19: We Must Leverage the Power of Digital Health

"A thoughtful, concerted effort - leveraging existing experience and robust enterprise-grade technologies - can have a substantive impact on the immediate and distal consequences of COVID-19."

Past experience has highlighted the utility of digital technology for treatment, diagnosis, support of self-management, and surveillance during public health emergencies. With a focus on low- and middle-income country (LMIC) contexts, this paper explores the role that telemedicine and other digital health tools can play in strengthening healthcare system capacity to respond to the COVID-19 pandemic. Namely, it presents several illustrations of possible digital technology applications, with the caveat that the use, feasibility, and importance of these applications and others will vary by factors such as country needs and existing infrastructure.

Examples include:

• Infection control through remote monitoring and training - Current levels of mobile phone penetration and internet connectivity allow for telemedicine solutions to be launched in most urban areas of the world. These services can protect health facilities from being overwhelmed by cases with mild to moderate illness and prevent the spread of COVID-19 to high-risk patients with other comorbidities. Voice calling may be the most appropriate way to provide such services in places where internet penetration is low or with subpopulations like older adults who may not be familiar with advanced technologies. Even so, the authors argue, "leveraging digital health for remote observation and care, where possible, may reduce costs and decrease the chances of infection spreading from patients to HCWs [healthcare workers] and back to other patients." Furthermore, centralising training through the internet or mobile phones can facilitate training of staff in rural and remote areas, where provider and training capacity is often variable.
• Home-based diagnosis and screening - The authors observe that digital technology used for these purposes can alleviate the need for suspected COVID-19 cases to leave self-quarantine to seek testing. For example, individuals or HCWs could call a central emergency operations centre hotline to request that trained personnel be dispatched to collect samples or assess and transport patients to the hospital if necessary. Centralised triaging and deployment of personnel and equipment is less common in LMICs, yet, if made more available, "it would preserve vital resources and act as an important form of risk mitigation."
• Empowerment through information - Considering that critical health advice to at-risk populations changes rapidly during public health emergencies, digital technology can help ensure that timely and accurate messages reach not only public health personnel but also community leaders and members. These technologies can help centralise COVID-19 information and clarify what people need to know in light of the massive amounts of information (and, in some cases, misinformation/myths) flowing at people through media channels such as television, newspapers, international and national websites, and social media. Furthermore, mass communication campaigns may be ineffective in countries with low literacy rates. Thus, for instance, a helpline could be set up to empower both patients and their caregivers with knowledge from doctors or health professionals trained in COVID-19 care on how to: minimise risk of spread, provide basic home care, and notify health authorities if the condition of a patient with COVID-19 deteriorates. In times of extreme stress like a pandemic, digital communication can also be used to deliver mental health support, provide counseling, and link individuals through online social networks. Various approaches can also be deployed to collect community feedback through digital methods without risking any healthy lives.
• Public health surveillance - Digital technology can offer a more agile and less resource-consuming approach to contract tracing than traditional door-to-door investigation to unearth detailed information. After confirming a case, his or her contacts can be traced over the phone and then information recorded in an electronic medical record (EMR) or contact management database. All contacts can then be followed up over time through the telephone, eliminating the need for face-to-face encounters and further infection risk.
• Epidemiological insights through crowd-sourced data - Previous efforts showed that incorporation of corrected Google Flu Trends while forecasting influenza-like illness improved accuracy when compared to reporting done only through formal reporting channels. The authors suggest that crowd sourcing artificial intelligence tasks or using social media data are promising strategies, though there are challenges (e.g., the lack of gatekeeping, in the case of social media).

To cite a specific country example, in Bangladesh, the government and a few private organisations have rolled out toll-free (or with minimal charge) hotline numbers to provide authenticated information and guidance on what to do if someone suspects they are infected by or actually show symptoms of COVID-19. This country has also seen "the viral spread of videos with animated viruses or catchy dance steps promoting hand washing, aimed at a tech-savvy generation of connected millennials."

That said, the authors call for a more concerted effort that involves the identification and acceleration of the use and adoption of digital strategies such as those described in this paper. They suggest that agencies like the World Health Organization (WHO) could help by rapidly convening the expertise needed to develop content (e.g., decision logic and workflows) and data models (e.g., recommended variable types and names). This approach could support developers in LMICs to expedite locally appropriate solutions that are also interoperable - "allowing deidentified data to be rapidly pooled as part of global efforts to understand emergent pandemic threats."