However, despite relying on established public health principles, countries across the world have had varying degrees of success in managing the burden of COVID-19.
Countries such as South Korea have integrated digital technology into government-coordinated containment and mitigation processes—including surveillance, testing, contact tracing, and strict quarantine—which could be associated with the early flattening of their incidence curves.
Although South Korea has incurred only 0·5 COVID-19 deaths per 100 000 people,
the USA, with three times as many intensive care unit beds per 100 000 people and ranked number one in pandemic preparedness before the COVID-19 pandemic, has sustained ten times as many deaths per capita.
|Tracking||Tracks disease activity in real time||Data dashboards; migration maps; machine learning; real-time data from smartphones and wearable technology||China; Singapore; Sweden; Taiwan; USA||Allows visual depiction of spread; directs border restrictions; guides resource allocation; informs forecasts||Could breach privacy; involves high costs; requires management and regulation|
|Screening for infection||Screens individuals and populations for disease||Artificial intelligence; digital thermometers; mobile phone applications; thermal cameras; web-based toolkits||China; Iceland; Singapore; Taiwan||Provides information on disease prevalence and pathology; identifies individuals for testing, contact tracing, and isolation||Could breach privacy; fails to detect asymptomatic individuals if based on self-reported symptoms or monitoring of vital signs; involves high costs; requires management and regulation; requires validation of screening tools|
|Contact tracing||Identifies and tracks individuals who might have come into contact with an infected person||Global positioning systems; mobile phone applications; real-time monitoring of mobile devices; wearable technology||Germany; Singapore; South Korea||Identifies exposed individuals for testing and quarantine; tracks viral spread||Could breach privacy; might detect individuals who have not been exposed but have had contact; could fail to detect individuals who are exposed if the application is deactivated, the mobile device is absent, or Wi-Fi or cell connectivity is inadequate|
|Quarantine and self-isolation||Identifies and tracks infected individuals, and implements quarantine||Artificial intelligence; cameras and digital recorders; global positioning systems; mobile phone applications; quick response codes||Australia; China; Iceland; South Korea; Taiwan||Isolates infections; restricts travel||Violates civil liberties; could restrict access to food and essential services; fails to detect individuals who leave quarantine without devices|
|Clinical management||Diagnoses infected individuals; monitors clinical status; predicts clinical outcomes; provides capacity for telemedicine services and virtual care||Artificial intelligence for diagnostics; machine learning; virtual care or telemedicine platforms||Australia; Canada; China; Ireland; USA||Assists with clinical decision-making, diagnostics, and risk prediction; enables efficient service delivery; facilitates patient-centred, remote care; facilitates infection control||Could breach privacy; fails to accurately diagnose patients; involves high costs; equipment may malfunction|
Contact tracing: the process of identifying people who might have come into contact with an infected person
Containment: the use of available tools to restrict the spread of infection
Lockdown: the active restriction and control of the movement of people by governments
Incidence: the number of individuals who develop a condition during a particular time period
Mitigation: the action of reducing the severity of the pandemic
Per-capita mortality: a measure of deaths in a particular population, scaled to the size of that population
Quarantine: the process of isolating and restricting the movement of potentially exposed or infected people
Screening: assessing for signs of disease in an apparently asymptomatic population
Testing: using medical procedures to confirm a diagnosis in individuals suspected of having a disease
Tracking: monitoring the spread of infection across locations
Planning and tracking
With these data, machine learning models were developed to forecast the regional transmission dynamics of SARS-CoV-2 and guide border checks and surveillance.
This integration allowed health-care facilities to access patients’ travel histories and identify individuals for SARS-CoV-2 testing and tracking.
Taiwan’s proximityto Wuhan, China, made the region particularly susceptible to COVID-19, but its efficient use of big data is credited for the low number of cases and deaths.
This information has been shared nationwide with health-care authorities to track the status of facilities, allocate health-care resources, and increase hospital bed capacity.
The Johns Hopkins University (MD, USA) coronavirus dashboard and the web-based platform HealthMap provide up-to-date visuals of COVID-19 cases and deaths around the globe.
AI algorithms allow the effect of the climate to be incorporated into the projections.
In addition to the absence of historical training data, social media and other online traffic have created noise in big-data sets, potentially producing overfitted or so-called lucky good fit models.
This noise must be filtered before accurate trends and predictions can be discerned. The accuracy, validity, and reliability of each AI forecast should be assessed when interpreting projections.
Screening for infection
High-performance infrared thermal cameras set up in Taiwanese airports are used to capture thermal images of people in real time, rapidly detecting individuals with a fever.
In Singapore, people have their temperature measured at the entries of workplaces, schools, and public transport. The data from the thermometers is tracked and used to identify emerging hot spots and clusters of infection where testing could be initiated.
Using mobile technology, Iceland collects data on patient-reported symptoms and combines these data with other datasets such as clinical and genomic sequencing data to reveal information about the pathology and spread of the virus.
This approach has added to the knowledge base regarding the prevalence and transmission of asymptomatic COVID-19. To date, Iceland has had the highest per-capita testing rate and among the lowest per-capita COVID-19 mortality rate.
Other countries offering widespread testing include Germany and South Korea.
and a national study is capturing resting heart rate with a smartwatch application, which could be able to identify COVID-19 emerging outbreaks.
These initiatives are either enterprise-driven or investigational and are not integrated into policy and practice.
The incubation period and the relatively high prevalence of asymptomatic infection compared with other infectious diseases limits the effectiveness of digital systems that screen vital signs or self-reporting of symptoms.
Researchers at the European Centre for Disease Prevention and Control estimate that a majority of passengers from Chinese cities would not be detected by screening because of these factors.
South Koreans receive emergency text alerts about new COVID-19 cases in their region, and people who could have been in contact with infected individuals are instructed to report to testing centres and self-isolate.
By identifying and isolating infections early, South Korea has maintained among the lowest per-capita mortality rates in the world.
Like South Korea, Singapore has maintained one of the lowest per-capita COVID-19 mortality rates in the world.
Data from the application are presented on an online, interactive map in which authorities can assess the likelihood of COVID-19 incidence across the nation.
With widespread testing and digital health interventions, Germany has maintained a low per-capita mortality rate, relative to other countries, despite a high prevalence of cases.
Not all exposure requires quarantine, such as when the exposed individuals are wearing personal protective equipment or are separated by thin walls penetrable by mobile phone signals.
On the other hand, relevant exposure could be missed when individuals do not carry their mobile phones or are without mobile service.
In addition, researchers at Oxford University (UK) have suggested that 60% of a country’s population would need to use a contact tracing application for it to be an effective mitigation strategy.
Quarantine and self-isolation
The QR code serves as a COVID-19 health status certificate and travel pass, with colour codes representing low, medium, and high risk; individuals with green codes are permitted to travel unrestricted, whereas individuals with red codes are required to self-isolate for 14 days. China also uses AI-powered surveillance cameras, drone-borne cameras, and portable digital recorders to monitor and restrict the gathering of people in public.
In Taiwan, electronic monitoring of home-quarantined individuals is facilitated through government-issued mobile phones tracked by GPS;
in the event of a breach in quarantine, this so-called digital fence triggers messages to the individual and levies fines.
In South Korea, individuals in self-isolation are instructed to download a mobile phone application that alerts authorities if they leave their place of isolation.
In Hong Kong, people in self-isolation are required to wear a wristband linked through cloud technology to a database that alerts authorities if quarantine is breached.
Iceland has launched a mobile phone solution to monitor individuals with COVID-19 and ensure that they remain in self-isolation.
Self-reported surveys such as those used in QR code systems only work when individuals are symptomatic and report their symptoms accurately.
However, such technological innovations could provide benefits when used in combination with other strategies.
This technology processes CT images in seconds, differentiating COVID-19 from other lung diseases and speeding up the diagnostic process substantially.
COVID-Net, an open-source deep convolutional neural network design available to clinicians across the globe, can quickly detect COVID-19 cases from other lung diseases on chest x-rays.
Machine learning algorithms developed in China can predict the likelihood of developing acute respiratory distress syndrome and critical illness among infected patients.
These prediction models can guide clinical decision-making and resource allocation, identifying regions and hospitals in need of critical care resources and medical supplies.
Countries such as the USA and Australia have also harnessed digital technology to provide remote care to patients with chronic conditions or with mild or moderate COVID-19 illness in their homes.
If implemented and delivered appropriately, virtual care can increase health-care access during the pandemic and after, but possible risks could include misdiagnoses, equipment malfunction, privacy breaches, and costs to the health-care system.
Risks of digital technology
Even within high-income countries, susceptible groups, such as those in low-income neighbourhoods or remote regions, might not have access to broadband signals, smartphones, or wearable technology such as smartwatches. To effectively implement digital technology globally, interventions should be tailored to the target regions; broadband access requires federal and private sector investment in technology and infrastructure.
At a regional level, subsidised mobile phone plans, loaner devices, free Wi-Fi hotspots, and training programmes could provide temporary solutions to these disparities.
In regions without infrastructure or sufficient funds to support cellular and data coverage, automated applications and devices that do not require continuous network access should be considered.
Some European countries are deploying an opt-in smartphone tracking application with anonymised data, no central database, and no GPS information.
The appropriate concerns about privacy and data security are potentially offset by facilitating a return to normal routine without a rebound in infections.
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