The COVID-19 pandemic continues to take its toll across the world, costing lives and bringing upheaval and change to societies and economies around the globe. While the global scientific community is racing towards effective vaccines or therapeutics, the most essential defence remains the most fundamental of public health measures, such as personal hygiene and mass physical distancing.
And yet, this is by no means an ‘old-fashioned’ response. Before the outbreak, digital technology had already been increasingly leveraged in China to accelerate, complement, and optimize health care service. Similarly, digital health technology has been deployed to address the most urgent needs during the pandemic, including in the immediate outbreak response and later in impact mitigation.
As the first country hit by the outbreak, China introduced a range of digital solutions throughout different stages of the outbreak. On February 2, the National Health Commission issued a notice that called for health authorities at all levels to strengthen the use of digital solutions to support the response to COVID-19, in collaboration with ministers across sectors and existing service providers.
As a response, national and local health authorities started to involve private companies to expand service coverage as the outbreak unfolded. Efforts were made to engage a range of companies, representing a mix of services from building ICT infrastructure, through aggregating and analysing data at scale, to enabling the availability of virtual and/or AI-powered healthcare services.
As the global pandemic continues, a case study of China’s digital experience may offer useful applications to other countries in their fight against the outbreak.
Immediate Outbreak Response
Contact tracing, testing, and surveillance – each an essential part of the overall public health measures in keeping the outbreak within a manageable scale – were each augmented in China by data-driven technologies.
One widely used application by the general public was one allowed people to trace if they were ever on the same train or flight or otherwise in close proximity with any confirmed cases in the past two weeks. The app, first developed by an independent software developer using data crawled from social media and websites where information on cases could be found, later became more reliable after having aggregating data from all-level public surveillance systems and the national transportation authorities, including the Ministry of Transport, China Railway Corporation, and Civil Aviation Administration upon approval by the State Council. Putting such risk assessments in the hands of the public enabled individuals to be better informed of their exposure level and gave specific instructions on the need to continue practicing social distancing and health monitoring. Three weeks after Wuhan lockdown, more than 140 million searches were made on the platform, which helped over 80,000 travellers discover that they had travelled with confirmed cases[1].
Another notable application, less known to the unexposed public but more recognized among health workers, was one used to improve diagnostic accuracy, ultimately making diagnostics more effective and available to larger numbers of people. Hospitals in Wuhan and nationwide deployed AI-powered CT imaging interpretation tools, which helped radiologists to reduce CT reading time from hours to seconds[2]. Some other tools allowed patients at community clinics to have their CT scan read by medical experts miles away[3]. This was critically important during the most intense weeks of the outbreak, because it helped minimize the chance of losing track of infected people, while expand diagnostic capacity without overwhelming the healthcare workforce.
The role of digital technology continues to evolve. In an effort to create an application that would assist national and provincial authorities in balancing resumption of economic and social activities with public health risks, in mid-February in a few districts in Zhejiang launched a traffic-light styled “Health Code,” where an individual’s is assigned a red-amber-green colour based on their health status (using self-reported body temperature, and COVID-19 like symptoms, as well as digitally determined contact history). The application has become a nationally recognized health permit to screen migrant workers for inter-provincial movements. With more than 900 million individuals – almost two-thirds of the population – registered[4] the application has the potential to drive continuous disease surveillance, contact tracing, and local risk assessment. Upgrades will continue to be necessary as more is learned about the transmission patterns of the infection[5].
Impact Mitigation
Previous outbreaks revealed that during a health crisis, people with treatable health conditions suffered disproportionately more because the healthcare system was stretched too thin to operate properly.[6] The COVID-19 pandemic is no exception and may possibly have posed an even more extreme result.
Many outpatient services were closed entirely either due to capacity issues or safety concerns, while intense social distancing measures made routine trips to hospitals and pharmacies an extraordinary task. Moreover, people with chronic health conditions such as hypertension, cardiovascular diseases, and diabetes, are also those with greater risks of falling critically ill or facing fatal consequence if infected. For this reason, many patients and their families even hesitated to visit a hospital.
The health authorities recognized this problem and issued a series of policies to promote telemedicine, as part of the ongoing “Internet + Healthcare” strategy. Online consultation services were boosted either by revamping existing privately-owned online telemedicine platforms or equipping public hospitals for such functions. On February 28, the National Health Commission and the National Health Security Administration took further steps to co-released a policy. It removed two other practical barriers when people turn to online platforms for healthcare, the physical barrier to receiving prescription re-fill delivery and the financial barrier from timely reimbursement[7].
During the outbreak, telemedicine even helped provide mental health support. The vision of rolling out systematic, accessible, and comprehensive mental health support for healthcare workers and general public was made possible by many popular online platforms.
Lesson Learned and Next Steps
The 2020's may turn out to be the decade when digital technology reshapes the health system. COVID-19 has certainly driven many developments in the first three months of 2020, as the digital health community continues to navigate how best to bolster classic public health measures.
In China, public-private-partnership is the cornerstone to many of the digital responses, with digital technology providers spearheading technological innovation within a national enabling policy and technological infrastructure. Many have seized the opportunity to demonstrate the capacity to address the practical needs of healthcare providers, patients, and the public, either via integrating into the formal healthcare grid or via standalone platforms.
Looking forward, challenges around technological maturity, scalability, data governance and impact on health outcome will remain to be solved before they could be institutionalized to strengthen public health services.
[1] http://www.sastind.gov.cn/n112/n117/c6808856/content.html