Tech News: Telemedicine could limit the spread of Covid-19
Cape Town - The runaway SARS-CoV-2 virus, which causes the respiratory disease Covid-19, has seriously impacted our lives.
A life-threatening exponentially progressing pandemic such as Covid-19 requires drastic responses and resulted in the South African government locking down the whole country.
Locking down a country is an important method to prevent the overrun of health systems as is predicted by the influential paper, Impact of non-pharmaceutical interventions (NPIs) to reduce Covid-19 mortality and healthcare demand, published by the Imperial College Covid-19 response team in the UK.
But it is quite possible that if health officials made greater use of technology at an early stage the unfolding of the virus could have looked differently.
Unlike other industries - such as retail, banking and manufacturing - public health has been slow in the adoption of emerging technologies.
The current usage of smartphone apps, artificial intelligence, chatbots, data mining and advanced data analytics in our highly connected world could be very effective in the combating of infectious diseases, but unfortunately the adoption rate in public health is relatively slow.
Innovation and the use of emerging technologies are often held back by bureaucratic constraints such as medical aid companies not paying for telemedicine visits and ageing government licensing regulations.
This modern and easily accessible technologies could have been much more effective containment tools in the fight against Covid-19.
The deepest problem is that traditional brick-and-mortar medicine is promoting virus exposure and spreading.
In South Africa, as in many other countries, people who develop Covid-19 symptoms present themselves to a medical doctor, clinic or a hospital. Although understandable, since people are driven by concern and fear, it is unfortunately creating the ideal circumstances for transmitting the contagious disease and putting numerous people at risk.
It would have been much better for people with Covid-19 symptoms to connect via an app to a doctor who can evaluate their symptoms while they are still in isolation at their home, thus avoiding the unnecessary exposure of any other person. Alternatively people could call a telemedicine centre where a doctor would determine if the person needs testing.
During the outbreak of the virus, more than a million people in Singapore used the telehealth MaNaDr for virtual visits. To curb the spread of the Covid-19 virus, physicians pre-screen patients with symptoms via the app and if they do not need to be hospitalised, they are advised to stay at home.
Patients are required to check in every evening to report if their fever persists or they experience any other severe symptoms. If the patients deteriorate the doctors call an ambulance to take them to hospital.
In the case of compromised patients, some telemedicine systems can measure several health metrics such as temperature, blood pressure and blood sugar.
Telemedicine has the further benefit that the data can be mined to predict the spreading of an epidemic such as Covid-19, thus allowing authorities to take preventative measures for an anticipated surge in demand for health services.
In Northern California, US, public health officials started tracking the data of Covid-19 calls.
The sudden increase from 200 to 3 500 calls a day was an early warning of community-based transmission even before the US had its testing in place.
Perhaps Covid-19 is a wake-up call of how important telemedicine is and that we need to fundamentally change the way we practice medicine and how our healthcare systems function.
TRACKING AND DATA ANALYTICS
Several South-east Asian countries used personal surveillance data to track the spreading of the virus. Vietnam and Thailand are tracking people through mobile apps, while authorities in South Korea track potential carriers using cellphone and satellite technology.
The Singapore authorities are using government data to do detailed mapping of the outbreak. The Singapore Personal Data Protection Commission has relaxed its privacy terms specifically to allow the collection, use and disclosure of personal data without the person’s consent. This allowed them to do extensive tracing of contacts.
Data protection laws in Europe and the US are driven by the intrinsic right to privacy and are probably one of the reasons that hampered extensive use of big data and data analytics to track the Covid-19 virus.
The General Data Protection Regulation (GDPR) requires anyone that wants to process a person’s data to first obtain their consent.
Mass tracking of people’s movements and those that have been in contact with them through the use of smartphone location data, violates this regulation.
Asian countries have much more pragmatic privacy legislation, making tracking in a health emergency much easier.
Governments will in future have to make provision in data protection laws that consent could be bypassed in situations of public health emergencies or national security.
In South Africa we could also use our health-related data much more productively, such as electronic health records, sales of prescription and over-the-counter medications. The tracking of non-prescription fever medication could, for instance, be a very crude indication of the spreading of a community disease.
The popularity of health-tracking apps on smartphones could also be used to detect sudden inactivity due to illness, as well as some vital symptoms and plot this according to geographical location to indicate emerging clusters of a disease.
Although controversial due to privacy issues, geotracking of phones in emergency situations could make the tedious task of tracing infected contacts much more effective since it could provide an exact record of a person’s movement.
If combined with the data of people in their contact list, the possible spread of an infection could easily be traced, thus making the testing more targeted.
In South Korea, geotracking was used to identify 1 300 members of a Seoul church infected by patient 31.
In Bangladesh, apps used to monitor hypertension and diabetes were modified to include Covid-19 symptoms.
The analysis of real-time data can quickly provide a snapshot of the spreading of a disease and makes the provision of facilities and equipment in advance much easier, as well as prevent the overwhelming of the health system.
In depth epidemiological data, including individual patient data; the time from infection to the onset of symptoms; if early testing and diagnosis improved patients’ outcomes; and mortality rate will enable epidemiologists to model the outbreak more accurately, as well as to determine the number of new infections triggered by each case (the basis reproductive number or R0).
LESSONS TO BE LEARNED FORM SOUTH KOREA, SINGAPORE
While the Us, the UK, Italy, Spain and other European countries are battling with soaring Covid-19 cases and deaths and imposed lockdowns South Korea seems to be a model to follow.
It appears as if South Korea has succeeded to dramatically slow the spread of the virus. The interesting thing is that they have done so without locking down entire cities or the country.
Although their extended and systematic testing program is integral to their success, the tracing and quarantining of the contacts of infected people by disease detectives through the use of technology played a major role.
Legislation enacted by the South Korean government after the Middle East Respiratory Syndrome (MERS) outbreak in 2015 gives the government the authority to collect mobile phone, credit card and other data from people who test positive to enable them to reconstruct their whereabouts and identify people that may be infected.
The information is shared on social media after it has been anonymized so that people can determine whether they had contact with an infected person.
Similarly Singapore is at this moment one of the safest countries in the world and reported its first two deaths only this past weekend.
The success of Singapore in dealing with Covid-19 can be attributed to the government’s speedy institution of border controls, aggressive testing, but also meticulous tracing of known carriers through technology.
Contact-tracing teams using mobile technology and surveillance cameras tracked down 7 957 contacts of confirmed cases and quarantined them.
The government also launched an app, TraceTogether, which uses Bluetooth to record distance between users and the duration of encounters. People had to give consent to the Health Ministry to use the information, which is encrypted and deleted after 21 days.
The data helps the Health Department to contact users where possible infection by an infected person is suspected.
In the graph included with this article he total confirmed Covid-19 cases for a selected number of countries are given.
Although demographics, population and other factors played a role, it is evident from the graph that the countries where technology has been extensively used such as South Korea and Singapore, did not experience exponential growth in the spreading of Covid-19.
These countries are in stark contrast to the exponential growth in countries such as Italy, the US, Spain and Germany. Unfortunately the currently growth speed of South Africa does not bode well.
The establishment of an analytics group happened only this week and only on Wednesday cellphone companies agreed to make cell-phone data available to government for tracing purposes.
We have survived pandemics in the past when people did not even know what a virus was. We will survive Covid-19.
However, due to several factors, we can expect much more virulent pandemics in the future. It is time that we devise strategies that use the abilities of technology to its fullest to deal with these invisible, but infinitely dangerous, new enemies. Perhaps Covid-19 will teach us that new technological tools are available to help contain infectious diseases. If only we do not realise it when we are already overwhelmed by the shear extent of the pandemic and do not have time to record and analyse the data.
Professor Louis C H Fourie is a Futurist and Technology Strategist.