Digital Health’s Cambrian Explosion in the time of COVID-19


Photo by Miguel Á. Padriñán on


The World is amid a pandemic not witnessed in living memory. The last crisis that impacted millions was AIDS and comparisons are, in my opinion, valid as government action was slow to address the crisis and many more died due to that inaction. At the time of writing, over 204,000 cases of COVID-19 have been confirmed globally. Health systems are mobilizing and accelerating their path to telehealth. In the USA, some rules and regulations have been altered to clear a way for adoption. Countries are looking to places like China to guide ways to flatten the curve; this also includes addressing mental health needs in stressful times. Like the original Cambrian explosion that occurred over 541 million years ago that moved the earth on a rapid path of evolution from single-cell organisms toward the complexity of species we see today, COVID-19 may well accelerate digital health to new places.

The clinical hallmarks of Adjustment Disorder include dealing with unexpected catastrophes, worries about money, illness and health issues, and death of a loved one. COVID-19 presents us with many of these circumstances in unprecedented numbers. I am not trying to pathologize the global citizenry; instead, look for ways to address the anxiety and stress caused by our shared uncertainty. In the most recent issue of the Lancet Psychiatry, Shuai Liu and colleagues from the Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China share how online mental health services were part of addressing COVID-19.

In the early days of China’s National Health Commission published guidelines on address COVID-19, including hotlines to support citizens experiencing psychological distress. The penetration of internet services and 5G in China facilitates the rapid adoption of online mental health services. WeChat is a universal messaging platform that China has leveraged to deliver support during the pandemic. Multiple forms of mental health questionnaires were loaded into this platform, and people could search and complete surveys which aided appropriate triage and subsequent support. Completed questionnaires show depression (50.4%), anxiety (44.7%), insomnia (36.1%) and stress-related conditions (73.4%) were the most common presenting issues. Having this signal on the kinds of psychological distress experienced by Chinese citizens allowed for better planning and allocation of resources amongst local health commissions. Academic and medical institutions coalesced around the provision of services leveraging WeChat so they could provide support in a widely used existing channel. Artificial Intelligence has also been leveraged to identify those at risk for suicide.

The World is looking at the Chinese experience with COVID-19 to mobilize local services. How will governments and health systems leverage telehealth and digital health optimally? We have a tremendous opportunity to digitally support people and health care workers in these unprecedented times. Be safe and well.


Thanks for reading – Trina
(Opinions are my own)



Online mental health services in China during the COVID-19 outbreak

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