Several months into the global pandemic of COVID-19 key opportunity areas are emerging that elements of digital health are well-positioned to solve. We have passed an inflection point well beyond the electronic medical record deployment to include rapid adoption and digital health implementation in the past twelve weeks. Hospital care has focused on care for those with COVID-19 and ensuring the capacity to address new cases and other kinds of care delivery has moved to telehealth.
A new viewpoint in the Journal of Medical Internet Research Public Health suggests we can leverage digital health to better prepare and address pandemics. The author, Sultan Mahmood, from Digital Healthcare Solutions in Bangladesh and colleagues from Johns Hopkins University Bloomberg School of Public Health, expressed concern that the pandemic has shown that public health approaches have been lacking for middle and low-income countries.
Currently, over five million cases of COVID-19 have been reported, and deaths in the USA are approaching 100,000 lives lost. Early learnings from China and Italy allowed many countries to put mitigation measures in place to flatten the curve. Remote monitoring of mild cases became part of many countries’ protocols to keep hospital beds available for those most impacted by the severest symptoms, and for those who ultimately need intensive care to manage the virus.
More challenging is remote monitoring of infection prevention and control, in countries like China, implementation of strict measures allowed for infection control but these measures provided challenges in other countries. When does infection control become surveillance from a citizen’s perspective? What communication is necessary to be transparent about data collection and data use so people can feel part of a collective solution to blunting the spread of the virus? Could Artificial Intelligence play a role in future pandemics by better identifying high-risk scenarios more rapidly? We posit this against the backdrop that trust in institutions is at an all-time low, what can countries do to regain confidence and make the necessary investments in public health for the greater public good?
The authors also suggest a move toward centralized training and capacity building delivered digitally to enable spread and adoption and also allow for local customization. A central approach could ensure all health care workers had access to the latest information in rapidly developing situations so they could stay abreast of the newest science. Online courses in different domains, delivered by the WHO could be one method to achieve this. How would this be reliability deployed in places where internet access is more challenging? How would this be performed, so it does not make the digital divide worse?
What home-based screening and diagnosis can occur, so people aren’t congregating in lines to get tested given the ease of transmission?, in the early days in China, these lines likely led to more infections occurring. Testing facilities are centered in large cities, how might this capacity be increased to include more geographic coverage without compromising the integrity of testing. In Milan, emergency services were leveraged to travel to homes of suspected cases so they could be tested and monitored at home. This move likely led to lower levels of community transmission. What can triage systems support to better manage testing and monitoring going forward?
Many countries set up helplines, so people experiencing symptoms or caring for those who were sick could get guidance and support. The authors reflect that the sheer volume of information coming from the media often confused the rapidly changing picture. So long wait times on these helplines meant people turned to their local media or social media for information. How do you achieve mass communication in countries where literacy levels are low? How do we ensure the science-based information is being shared broadly without a political slant being placed on it?
I have addressed the ongoing psychological needs from COVID-19 in other blog posts. This remains a crucial area of focus as we move through different phases of opening our localities in a safe manner. What lasting impacts will weeks of sheltering-in-place have on the general public and those already experiencing depression and anxiety? Ongoing support will be necessary as we all adapt to the new normal. The road ahead also leads to better contact tracing so local outbreaks that can be managed and mitigated. Will people be willing to share data on their health status and movement, so this can be realized? Can public-private partnerships be created to support public health, and will the levels of trust exist for the level of monitoring needed to prevent a second wave?
A lot has happened globally in the last three months- what lessons can we take forward to have better systems in place to ensure health systems are not overwhelmed by caring for those sickest from the virus. How can we create public trust and reliable sources of information that are shared freely and not weaponized to land a political message? Digital health can and must be a foundational element in addressing this pandemic if we are to blunt this and future pandemics and ensure more people are in their lives, with their families safely.
Thanks for reading – Trina
(Opinions are my own)
Global Preparedness Against COVID-19: We Must Leverage the Power of Digital Health
JMIR Public Health Surveill 2020;6(2):e18980 DOI: 10.2196/18980
PMID: 32297868 PMCID: 7164944