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 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 17  |  Issue : 1  |  Page : 146-151

Utilizing digital technology in the public health system during an epidemic


1 Rtd Additional Chief Secretary to Government of Gujarat, Gandhinagar, Gujarat, India
2 Assistant Professor, Gujarat Technological University, Ahmedabad, Gujarat, India

Date of Submission18-Feb-2021
Date of Decision10-Mar-2021
Date of Acceptance22-Mar-2021
Date of Web Publication25-Jul-2022

Correspondence Address:
Mr. Poonamchand Parmar
Research Scholar, Rtd Additional Chief Secretary to Government of Gujarat, Gandhinagar, Gujarat

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_76_21

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  Abstract 


The people-centric public health measures and an integrated model of health service delivery can be obtained through the efficient utilization of digital technologies during the epidemics. The classical epidemic control measures like contact tracing, social distancing, and quarantine should be supported by the efficient analytical digital tools. This paper aims to explore the feasibility of digital interventions during a pandemic situation such as COVID-19 to enhance monitoring, surveillance, detection, and prevention of the spread of disease, along with to mitigate the impact on health services. The accessible health services can be ensured with the effective use of digital tools; web-based and cloud-based services, Internet of things, smartphones mHealth, data analytics, etc., to support an emergency public health response, real-time tracking, data monitoring, virtual clinics, and telemedicine/teleconsultation during a disease outbreak. Digital technologies to advance the management of public health services and to balance between data privacy and of public health measures should be considered for the effective management of an epidemic.

Keywords: COVID19, digital technologies during epidemic, digital technologies, management, public health


How to cite this article:
Parmar P, Vaghela K. Utilizing digital technology in the public health system during an epidemic. J Datta Meghe Inst Med Sci Univ 2022;17:146-51

How to cite this URL:
Parmar P, Vaghela K. Utilizing digital technology in the public health system during an epidemic. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2022 Aug 18];17:146-51. Available from: http://www.journaldmims.com/text.asp?2022/17/1/146/352249




  Introduction Top


The creation of comprehensive and integrated health services is being aimed since the Declaration of Alma-Ata in 1978 which encouraged modifying health services as per the need. Digital technologies were in the emerging phase during the Declaration of Alma-Ata was agreed upon four decades ago. However, digital technologies of the present era such as smartphones, computers, the World Wide Web, Internet services, cloud-based services, and Internet of things (IoT), etc., have shown a revolutionary impact in public health.

The new viral pathogen severe acute respiratory syndrome–coronavirus type 2 (SARS-CoV-2) emerged in late 2019, leading to a tremendous rise of new cases and causing thousands of cases of coronavirus diseases (COVID-19) to date World Health Organization (WHO). According to the WHO, the virus is likely of bat origin, with a possible intermediate animal host, and most of the first documented cases were linked to the environmental exposure in the Huanan Seafood Wholesale Market in early December 2019. Various available analyses suggest that SARS-CoV-2 is more infectious and less virulent than SARS-CoV-1. Due to difficulties in tracing mild or asymptomatic infections, the SARS-CoV-2 may have greater epidemic potential. Hence, the only effective measure is that of classical epidemic control, such as contact tracing, social distancing, and quarantine[1],[2] should be supported by efficient monitoring and analytical tools. This article aims to explore the feasibility of digital interventions for effective public health measures during a pandemic situation like COVID-19.

A strong, established a scientific foundation of digital tools and technologies for public health emergencies is paramount, which leads to resources such as telemedicine, electronic health records, and wearable sensors; allow people to manage their health more effectively and provide better ways of diagnosing diseases. Emerging advanced information technologies in the fields of big data and artificial intelligence offer a platform for monitoring the impact of policies on public health. With the global spread of COVID-19 since late 2019, there is a proliferation of scientific information and publications that observed the effects of approaches such as big data, wearable, and digital devices in surveillance and epidemiological investigations.

Moreover, digital technology can enhance public health education and communication strategies which enable recommendations including guidance on social distancing and self-isolation, how to closely monitor symptoms, recommendations on testing, and when to contact a medical provider, etc., big data generated during surveillance, monitoring may also provide opportunities for studies of viral transmission and guiding policies to enhance area-specific preparedness.

Tackling the direct impact of the pandemic is important to maintain critical medical and public health services. Study of efficient use of digital interventions includes modeling of disease activity and areas of spread and modeling of the preparedness and vulnerability of countries in fighting a disease outbreak.[3] Large-scale collection of data can help to curb the COVID-19 pandemic, but it should not neglect data privacy. Moreover, best practices can also be identified to maintain responsible data collection and data-processing standards on a global scale. The present study aims to suggest the utilization of digital technologies for the management of public health services during a pandemic with unusual steps and ensuring data privacy during the data sharing in the digital world.


  Digital Solutions to Advance the Management of Public Health Services during a Pandemic Top


The COVID-19 crisis is displaying the potential of digital health technology to manage some of our greatest public health challenges during the epidemics. During a pandemic situation, digital solutions can play a vital role for epidemiologists and public health authorities involved in the development and implementation of surveillance systems for infectious diseases and in assessing the most appropriate interventions for dealing with disease outbreaks and pandemics.

The efficient people-focused approach for the digital transformation of health services will ensure accessible, affordable, and transparent technological developments. The novel virus that has caused pandemic SARS-CoV 2 poses a particular challenge where nearly half of transmissions happen before an infected person has symptoms.[4] The virus can spread for days before public health managers even learn/identify a spreader. Fraser, with Oxford clinician David Bonsall and colleagues, designed a model to quantify instantaneous digital contact tracing which may influence the spread of the virus. [1] To stop the epidemic of SARS CoV2, health officials must reduce the reproduction of the virus, i.e., the average number of person affected by each infected person.

The rest of the article discusses about different digital interventions for controlling the spread of disease, management of epidemic disease, predicting analytics, and challenges that can be encountered and the steps to mitigate these challenges.


  Controlling Spread of Disease by Real-Time Data Capturing Top


During the starting phase of the COVID-19 pandemic, their treatment was not available, and the vaccine development is still in primary stages, which raises the essential need to test any infected individual and tracking of infected people. With the emergence of new viruses, the immediate steps to control the pandemic include contact tracing, quarantine, isolation, and symptomatic treatment. Many governments, companies, and citizens' movements have developed digital solutions and mobile health (mHealth) initiatives to keep the population informed and help to manage the crisis.

The research to quantify the dynamics of COVID-19 transmission suggests that a large number of transmissions occur before individuals develop symptoms.[1] Thus, isolating symptomatic cases may prove marked delay in the control of the spread of disease and tracking their contacts through classical epidemiological methods is likely to be too slow and resource-intensive to achieve epidemic control. The contact tracing with a mobile phone app which could dramatically reduce onward transmission from contacts to a level that is sufficient to reach herd protection[4] and so stop the virus from spreading in a population.

Various real-time dashboards are been developed by international, national, state, and regional health authorities. The Johns Hopkins University Center for Systems Science and Engineering dashboard's interactive map [Figure 1] locates and tallies confirmed infections, fatalities, and recoveries.[5],[6] Graphs detail virus progress over time. Viewers can see the day and time of the most recent data update and data sources.
Figure 1: Johns Hopkins University Center for Systems Science and Engineering dashboard - interactive live updating dashboard global real time data statistics – COVID-19[5],[6]

Click here to view


The WHO directs and coordinates international health, combating communicable diseases through surveillance, preparedness and response, and applying geographic information system (GIS) technology to this work. On January 26, 2020, the WHO unveiled its ArcGIS Operations Dashboard for COVID-19, which also maps and lists coronavirus cases and total number of deaths by country and Chinese province, with informational panels about the map and its data resources [Figure 2].
Figure 2: The World Health Organization COVID-19 situation dashboard. Screenshot date: August 21, 2020[3]

Click here to view


SARS-CoV-2 persistently tests the capacity of public health systems. Since the beginning of the outbreak, the health authorities have learned about COVID-19 pandemic disease and its treatment from the data generated from the sharing of sketchy observations and small case series. However, epidemiologists and other health professionals use modern technology to communicate and tried to build robust data-sharing systems for large scale near real-time analysis. However, the absence of a single monitoring platform for real-time data sharing and tracking of infected and contact person has slow down the enforcement of public health emergency measures.

Mobile applications in particular have the potential to improve public health surveillance by bolstering contact tracing strategies to contain and reverse the spread of pandemics. Besides smartphone apps, features such as geo-location (through global positioning system) and social media entries may allow, under certain conditions, for better monitoring and tracking of situations in real-time and enable faster responses in the right location, including the notification of at-risk individuals.

Source: Adopted from https://inc42.com/buzz/with-127-6- mn-downloads-aarogya-setu-tops-contact-tracing -apps-worldwide/.

As depicted in [Figure 3], one of the popular and simple modes for contact tracing is through various digital applications. In India, the government is largely relying on the data collected through IT-enabled integrated hotspot analysis system (ITIHAS) developed for surveillance and containment strategies, apart from manual contact tracing. India ranks four in terms of the highest adoption rates with 12.5% of its population having downloaded the Aarogya Setu app, but the country ranks first in terms of the absolute number of people downloaded a contact tracing app.[7] It should be noted that India has made downloading the application mandatory for the several sections of its population, such as those in government or private service, those travelling in public transport, among others, but the ITIHAS–Aarogya Setu app lacks in the parameters of “data minimization.”
Figure 3: Adoption of contact tracing app by the percentage of population and top five countries by number of total contact tracing app download

Click here to view


The various contact trace apps improve surveillance and help in cluster projection. Unfortunately, patient-level COVID-19 data are not publicly available and the available real-time data also lack comprehensive information. In this interconnected digital world, public health experts may imagine a unifying multinational COVID-19 electronic health record that helps global researchers to apply domain expertise.[5],[7]


  Management of COVID19 Cases Top


The COVID-19 global public health emergency has opened doors for digital technologies to advance in public health with a sudden increase in telemedicine services worldwide. From public health messaging to symptom checkers and more intrusive tracing and tracking apps, a range of solutions is helping to tackle the challenges posed by the pandemic especially constraint in human resources. In the present era of electronic health records, physiologic, laboratory, imaging, decision-making, and treatment data are continuously recorded. Inferences drawn from these data can inform epidemiological inquiries and guide treatment protocols when clinical trial data do not exist in new virus infectious epidemic disease situations like COVID-19.

The study to explore the potential application of inter-related digital technologies, i.e., IoT, big-data analytics, Artificial Intelligence, and block chain to supplement traditional public-health approaches for addressing pandemic COVID-19. [8] Health systems can use digital technologies to deploy “virtual clinics” using telemedicine. This will help to redirect interventions from secondary and tertiary care health facilities to people's homes through telemedicine, remote care, and mHealth which is already transforming health services into mobile/moving public health systems.

Services such as home monitoring of blood pressure, medication adjustment, and blood-urine testing are the keys to the people-centric health services, especially during public health emergencies. Technologies that enable patient access to personalized information, appointment booking, and tools to manage their chronic conditions provide further support that can be achieved through electronic health records. IoT-electronic sensors enable measurement of vital signs and activity tracking to assist staff in monitoring patients at risk and prescription of medications can be accurately and securely shared through electronic prescribing, if required telemedicine/teleconsultation can also be utilized.

A recent study has shown that once the COVID-19 reaches the peak, hospitals get overwhelm gets overwhelmed and the death rate jumps.[9] AI is an effective tool in predicting medical conditions and adverse events and help caregivers with medical decision-making. The data-driven predictive analytics algorithms are based on AI and machine learning to determine the health risk and predict the mortality risk of patients with COVID-19. This kind of system can help hospitals and medical practitioners to decide who needs to get attention first, who have a higher priority to be hospitalized, triage patients when the system is overwhelmed by overcrowding and helps to decrease delays in providing the necessary care. The customized algorithm predicts the mortality risks based on patients' physiological conditions, symptoms, and demographic information.


  Predicting Analytics and Resource Planning Top


Algorithms can be developed to help triage patients in clinical or emergency room settings by the levels of severity and can facilitate the discovery of new COVID-19 therapies or vaccines. However, one should also consider tackling issues of data privacy and public trust to develop responsible data collection and data-processing standards. Ethical data collection practices may dictate a limited collection of what is necessary to achieve a specific public-health objective. The digital discussed that dependence on digital data sources can have particular value in the tracking of novel outbreaks.[10]

After selecting the data feature for information extraction and data evaluation, various machine learning algorithms can be used to build a predictive model. The Various algorithms to build predictive analytics, where neural network, random forest, support vector machine, decision tree, and logistic regression were used to achieve the best performance and accuracy.[11] The results of demonstrated that the algorithm based on the patients' physiological conditions, symptoms, and demographic information can predict the mortality risk in patients with COVID-19.[11]

Real-time epidemiological data are essential, especially during epidemics for monitoring the situation and anticipate the spread of infection to plan resources and interventions. However, present data sources have been only focusing mostly on aggregated case counts per geographic location. The opportunities created by digital technologies in achieving the vision for equitable public health services. In the long run, digital biomarkers and artificial intelligence-based algorithms require evaluation of analytic validity, clinical validity, and utility to provide maximum benefit for acute public health response.[12] ITHAS–Aarogya Setu app helps in predicting emerging clusters of the disease.[7]

Source: Adopted from https://healthmap. org/en/.

HealthMap is run by a team of researchers, epidemiologists, and software developers at Boston Children's Hospital, USA, and uses online media sources for real-time surveillance of emerging public health threats.[13] HealthMap is an interactive digital tool that collates outbreak data from a range of sources, including news media, social media, validated alerts, and expert-curated accounts.[3] HealthMap's interactive map for SARS-CoV-2 offers real-time geolocated updates from these sources to better understand the progression of the pandemic [Figure 4].
Figure 4: HealthMap: Analyzing and mapping online informal sources

Click here to view



  Multidimensional Use of Digital Technologies to Tackle an Epidemic Top


Ultimately, the application and evaluation of digital tools to address a major global public health emergency[14] like as COVID-19 can also provide an important path for applying such technologies more effectively for future planning related to human resources, equipment, and in other areas of health care and public health. Critical care medicine is one of the greatest examples of effective utilization of smartphones linked with multiple IoT devices constitute another step forward and have led to the development of apps for use by both medical professionals and patients.

To evaluate the use of advancing technology during COVID-19 pandemic medical management, The author and on duty doctors of U N Mehta Institute of Cardiology and Research Center, Ahmedabad, have made E Critical mobile application to manage critical patients suffering exclusively from COVID-19. This application having all the parameters which are useful to manage critical patients, i.e., ventilator settings, ionotropic supports, vitals monitoring and routine blood, and radiological investigations. This app is also featured with a critical alert alarm which will directly give alerts to associated consultants attached with patients treated in no time.

This E-Critical mobile application is found beneficial for inaccurate diagnosis and evidence-based treatment. Hence, the effective use of digital technologies will remove subject-specific bias and also helpful to record patient history with minimal errors. These devices provide better access to the latest drug information and thus help make better decisions. They automate a lot of paperwork which frees up medical practitioners' time. The E-Critical mobile application is being used in the Speciality Hospital since April 2020 and has been found helpful in improving the quality of health care dramatically by providing “better point-of-care coordination,” “seamless data flow,” “direct patient management,” “enhances physician efficiency,” “increases diagnostic accuracy,” and above all ensures “real-time communication” during COVID-19 epidemic.

It is required to have a multidimensional, multispectral use of digital technologies[14] for effective management of an epidemic which shall include support for a patient/an individual, support to health service providers/medical practitioners, and support to decision-makers [Figure 5].
Figure 5: Proposed utilization of digital interventions for public health emergency of pandemic

Click here to view


The epidemic is directly linked with required resources, the real-time situation of infected patients, contact persons, clusters – hotspots, etc.,; hence, the epidemic status always guides health authorities to direct the resources as per the need. In COVID-19 times, communicating the purpose, objectives, and direction of digitalization in public health is increasingly important for effective management and administration by public health authorities. It is essential to offer a platform of digital health interventions [Figure 5] including required additional digital support, telediagnostics, and telemedicine or virtual clinics. The increasing data-driven solutions present new ethical challenges inform of securing data privacy.


  Digital Solutions to Balance Data Privacy and of Public Health Measures during a Pandemic Top


The COVID-19 pandemic has opened up an important paradigm related to the balance between privacy and enforcement of public health measures. One of the most frequently used digital interventions during the COVID-19 pandemic is tracing of the infected individual and their contacts through smartphone applications mHealth. Tracing an infected person during ongoing COVID-19 pandemic requires the utmost focus as testing to diagnose infections has been painfully slow to ramp up with fewer resources.[4] Even state and local health departments arrange for testing resources, they may not be able to interview every patient and follow-up with every contact this highlights interests of privacy with public health measures.[2],[15]

Contact tracing digital tools are being utilized worldwide to identify exposed individuals have shown promise in facilitating early responses to minimize disease spread.[14] However, these mHealth tools have come at the expense of personal data privacy, leading to concern over widespread misuse despite public health benefits (CDC) (WHO).[2],[12],[15] The public health measures also relies on a broader system consisting of connection network, data sharing, data storage, system data analytics, and integration with the existing backend management system. Therefore, constant support for quality improvement and data security needs to be addressed Data protection and privacy along with fundamental rights even during public health emergencies.[1],[6],[7],[8],[9],[10],[11],[12]


  Conclusion Top


A continuous debate on emerging ethical issues, coupled with periodic revision of available evidence, relevant guidelines, and policies, is needed. Digital health should contribute value to existing public health measures during epidemics. The broad spectrum of activities covered by public health adds a layer of complexity in the framework for the digitization of public health emergencies. The pros and cons of digital interventions should be well discussed and constraints in public health services should be addressed more strategically.

Mobile devices have created a new communication channel between health-care service providers and patients. However, the benefits of mobile devices in health care go beyond the communication channels. They enable better co-ordination, improve diagnostic accuracy, and build a bridge of trust. GIS technologies center on web-based tools, improved data sharing and real-time information to support critical decision-making during public health emergencies. Digital technologies have already opened up a range of possibilities for shaping the future of public health emergency services and ensuring effective public health policies. A recommitment by governments to the goals of accessible health services and its values of inclusiveness promises more changes to come with digital technologies. The effective use of digital tools to support an emergency public health response is relevant during the COVID-19 outbreak and in the future will become even more prominent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ferretti L, Wymant C, Kendall M, Zhao L, Nurtay A, Abeler-Dörner L, et al. Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. Science. 2020. doi:10.1126/science.abb6936.  Back to cited text no. 1
    
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World Health Organization, Corona Virus Disease dashboard, 2020. Available from: https://covid19.who.int/. [Last accessed on 2020 Oct 26].  Back to cited text no. 2
    
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Khoury M, Bowen S, Braun P. Genomics and Precision Health, Centers for Disease Control and Prevention 2020. Available from: https://blogs.cdc.gov/genomics/2020/04/06/using-digital/. [Last accessed on 2020 Jul 16].  Back to cited text no. 3
    
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Servick K. Cellphone tracking could help stem the spread of coronavirus. Is privacy the price? Science, 2020. doi:10.1126/science.abb8296.  Back to cited text no. 4
    
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Harshit R, Aarogya Setu Tops Contact Tracing Apps Worldwide, 2020. Available from: https://inc42.com/buzz/with-127-6-mn-downloads-aarogya-setu-tops-contact-tracing-apps-worldwide/. [Last accessed on 2020 Jul 20].  Back to cited text no. 7
    
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13.
Kamel Boulos MN, Geraghty EM. Geographical tracking and mapping of coronavirus disease COVID-19/severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic and associated events around the world: How 21st century GIS technologies are supporting the global fight against outbreaks and epidemics. International Journal Health Geographics 2020;19:8. doi: https://doi.org/10.1186/s12942-020-00202-8.  Back to cited text no. 13
    
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Hossain N, Househ MS. Using HealthMap to Analyse Middle East Respiratory Syndrome (MERS) Data. Unifying the application and foundation of Biomedical and Health Informatics, In ICIMTH. IoS Press 2016;213-16.  Back to cited text no. 15
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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