Since the novel coronavirus outbreak started in Wuhan, China, in December last year, we’ve seen the world focus on little else.
COVID-19 is putting strain on governments globally, and with over 90% of all cases reported so far coming from four countries, but over 100 affected, the pressure is now on officials to identify the response needed according to their own scenario.
Over the weekend, the UK outlined emergency legislation ahead of an expected move from the ‘contain’ – detecting early cases, following up close contacts, preventing – phase of its four-stage strategy to ‘delay’ – slowing the spread.
As of the morning of 11 March, there were 456 confirmed cases here, and six deaths.
England’s deputy chief medical officer Dr Jenny Harries defended the decision to delay closing schools and put into motion other strict measures, telling BBC Breakfast these could follow as the number of cases in the UK start to increase rapidly in the next couple of weeks.
Italy, however, the worst-affected country after China, told its citizens to avoid all non-essential travel, extending emergency measures, with all schools and universities closed, gatherings cancelled and more.
In the midst of all this, the health tech space is eyeing up an opportunity.
In an interview with the New York Times at the beginning of March, World Health Organization (WHO) official Dr Bruce Aylward said China first reorganised its medical response to the outbreak by moving half of all medical care online.
In England, NHS bosses recently asked GP surgeries to start carrying out more remote consultations in an effort to mitigate risks. One surgery in London texted patients to say: “Due to coronavirus, starting Monday 9 March all patients’ appointments have been changed to telephone consultations excluding blood tests. If you have an appointment booked, please do not attend the surgery. The doctor will call you at your appointment time and conduct a telephone consultation.”
To tackle coronavirus we are taking a digital first approach – so wherever possible people can access primary care and outpatient appointments through phones and digital means pic.twitter.com/hNAA3jmgnf
— Matt Hancock (@MattHancock) March 10, 2020
The aim is to help reduce the risk that, for instance, someone infected could come to the surgery and transmit the virus not only to other patients, but healthcare professionals as well, potentially reducing the number of workers, already under strain, that could care for those affected.
The Guardian reported that Great Ormond Street hospital recently had to cancel surgery for children with serious heart problems after a health professional contracted the virus. A similar thing happened at University Hospital Southampton.
“The coronavirus, although it’s such a negative aspect of our lives and [in terms of the effect] on other people, actually, I think there is an opportunity here to rethink the whole model of the way we see our patients, certainly around technology, of course,” says virtual reality surgery pioneer Dr Shafi Ahmed.
Cofounder of VR education company Medical Realities, Dr Ahmed is an outspoken supporter for the use of technology in healthcare. Back in 2016, he became the first surgeon to livestream a surgical procedure in VR, which was watched by millions around the world.
Below, you can see him connect to colleagues in the US to demonstrate the use of telepresence, with a platform from Aetho, and share insights on COVID-19 while avoiding travel and other potential risks.
At MobiHealthNews, we recently reported on the rise in digital epidemiology tools, chatbot helpers and other technologies aiming to help stakeholders tackle the crisis.
Some have even gone as far to say that the coronavirus outbreak could be the ‘tipping point’ for nay-sayers to realise the potential of telehealth. Dr Ahmed warns that although this could prove to be an inflection point, it’s too early to tell how it will impact the implementation of new technologies to better care for patients.
“The potential for COVID-19 to encourage deployment of digital transformation is considerable,” says Dr Charles Alessi, chief clinical officer of HIMSS, owner of MobiHealthNews. “In the UK, we are still at 1% in terms of using ‘digital first’ – consultations in primary care. This may well prove to be the event that transforms that.”
Dr Saif Abed, founding partner & director of cybersecurity advisory services at AbedGraham, cautions that while telehealth will not see an “overnight revolution of adoption”, it might move up in the list of priorities for receiving strategic investment.
“The reason there will not be a revolution is because there are a lot of security, regulatory, infrastructure and, of course, funding considerations that need to be managed before we can see the type of adoption that can support local level interventions but can also be leveraged for national level reporting,” he cautions.
Now, a lot of the global efforts are focused on limiting the spread of the outbreak. Dr Abed warns that, firstly, disease surveillance is dependent on real-time, good quality data that can be shared to support analysis, modelling and forecasting.
“Consequently, EHR systems have a critical role to play for symptom logging, admissions reporting and management tracking. However, without interoperability of data sharing and reporting between solutions across acute, primary and community care systems it is difficult to turbocharge the analytics solutions that are intrinsic to mapping the impact and behaviour of COVID19 and its associated virus SARS-CoV-2,” he explains.
And while it is clear that governments will need to work with all major stakeholders to respond to the threats posed, some question the feasibility of putting this into practice.
“Health systems across the world are currently dealing with practical resource constraints of bed numbers and ventilators. Depending on the digital maturity of their region, they may have all the right systems in place to support effective disease surveillance. The real question is whether commercial and technical constraints on the supplier side of the equation make it difficult to do this. This is why government intervention is critical at these times in terms of its relationship with the private sector,” Dr Abed says.
Lisa Rice-Duek, registered nurse and clinical programme manager for HIMSS, says the outbreak has certainly put a focus on the benefits of remote care. But she cautions: “There is an issue of digital literacy for older patients who might not have the necessary tech skills to access remote support. With studies showing that 40% of people over 75 use the internet, compared with 97% of 16-49 year olds, according to a report from NHS Wales, it is clear the elderly, who are most at risk from viral outbreaks such as coronavirus, are the least likely to be able to seek remote care.”
However, a number of initiatives have been launched to promote digital inclusion. Rice-Duek says nurses and other care staff from the acute and community sectors are “ideally placed” to provide the necessary education.
“There is a focus in many countries on increasing healthcare staff’s digital engagement in order to pass this knowledge on to their patients,” she explains.
Fighting against misinformation on the digital battlefield
Perhaps unsurprisingly, with the recent outbreak came a wave of false theories on social media aiming to mislead and deceive people. One of the most popular ones claims the virus was created in a secret government lab in China.
Dr Ahmed, who is an advisor in digital health, transformation and innovation for the Department of Health in Abu Dhabi, says there was a realisation early on over there that it was important to bring various players on board to look at education. Using social media and other platforms, they sought to communicate accurate information about the outbreak to the public.
In the UK, the NHS is working with tech giants including Google, Twitter, Instagram and Facebook on a similar effort. The government has also set up a new unit tasked with tackling the dissemination of false and misleading claims.
But that’s not all.
“Apart from the usual conspiracy theories and fake vaccines, the most insidious things I’m encountering are actually phishing emails using COVID-19 to get the recipients to open attachments or otherwise trigger malware being downloaded on their systems,” says Dr Abed.
“This really angers me because it takes advantage of people when they are most anxious and vulnerable to potentially commit even more damaging crimes against them such as identity or financial theft.”
To address this, he says that national level communications warning about disinformation, as well as reporting from credible sources, will be crucial.
“Beyond that, we have to ensure there is a safety net for those that are taken advantage of while ensuring we pursue the perpetrators wherever possible, though this is easier said than done unfortunately,” Dr Abed concludes.