Data-driven early detection health ecosystems: A promising way to boost resilience to COVID-19

While the rates of fatalities are slowing in some countries, COVID-19 is continuing its spread with a global rise in mortality. Measures to combat the pandemic have varied across states and governments and have had different levels of success. However, one thing they have in common is that all these interventions have been almost entirely reactive. As we now look toward the future, countries that have implemented lockdowns and social distancing must consider how to ease rules and "open up" their economies in ways that avoid a second wave of infection. This requires a more proactive, targeted and thoughtful approach. Data-driven early detection health ecosystems are a central part of the solution. 

Ecosystems and the advantages of contact tracing

The impact of the COVID-19 pandemic on healthcare systems and infrastructure has been severe: Makeshift hospitals and morgues have been built in multiple countries, non-emergency operations have been pushed back and access to other healthcare services, such as reproductive clinics and non- emergency operations, has been interrupted. Rates of infection and mortality of healthcare workers have spiked across regions.

In order to decrease the infection and mortality rates, and importantly, "flatten the curve" to avoid the over-extension and destruction of their medical services, most people have accepted state limitations on their personal freedoms and the resulting economic effects of these measures. While the collective mentality has been impressive, these shutdowns are not economically sustainable, and people will start and indeed already have chafed against these wide restrictions. We will need to develop a solution that will call for a collaboration of all sectors of society utilising technology.

Data driven health ecosystems are a big part of the solution, but what is needed is not necessarily technological.
Corinne Fitzgerald, Researcher, Swiss Re Institute

We have the ability to work towards efficiently offering the services and knowledge that people need in one place, what we refer to as "digital ecosystems." Pandemic-specific digital ecosystems will make adaptations and virus spread avoidance easier and more efficient, allowing for smart and safe resumption of many "normal" activities and tasks in public. We see the beginnings of digital ecosystems employed in this manner – for example, in China, there have been great examples of cross sector collaboration in the development of their ecosystems. WeChat and Alipay both have begun to include links to relevant services, including e-medicine (telemedicine services, including counselling), official government statistics and e-commerce so that people can buy sanitizer and masks through their preferred partners (Grover, 2020).

Figure 1: Reduced mobility patterns vs. baseline in comparison between selected Asian and European countries

While countries in Europe, like Italy and Spain, enacted extreme lockdowns to counter massive outbreaks of the virus, some countries in Asia like South Korea enjoyed comparatively more freedom whilst undergoing containment measures to try and control the virus. From the above figure we can see that there was even an increase of activity in parks in South Korea, Taiwan and Japan. These countries' use of contact tracing in particular, which has been hailed as the crown jewel of defence efforts against the virus, was an important part of their strategy, but other efforts such as temperature screenings and mass testings were also implemented on a wide scale (New Yorker, 2020).

Breaking down the promise of health ecosystems in the fight against COVID-19

Figure 2: Essential phases of the COVID-19 health ecosystem

As is clear by the strategies employed in countries like South Korea, myriad applications in the medical, behavioural and mobility IoT space already exist that would be useful in the fight against the spread of COVID-19. These applications, brought together and appropriately regulated, would deliver greatly enhanced data value for individuals and would allow official bodies to deliver life-saving services.

Figure 2 illustrates how a health ecosystem would work at each stage of the patient journey. As mentioned above, digital ecosystems would be especially beneficial in prevention efforts like contact tracing. In addition, they would be helpful in self-diagnosis. According to a recent WHO study, medical parameters such as raised heart rate, increased respiratory rate, and reduced oxygen saturation were typically found in COVID-19 patients (WHO, 2020). These indicators are easy to self-monitor with tools we have available today, and early identification of critical levels and prediction of vital parameter changes would allow us to swiftly take appropriate action.

In the case of an infected patient, digital platforms and technology are also promising. In the illustration, each circle shows the type of care necessary for the infection stage, e.g. decentralised mobile care vs. the next stage of home & virtual care. They're broken up by the technological interventions that either enable management or healing, i.e. 'symptom detection' or 'diagnostic testing'. A health ecosystem should allow patient flow to be as seamless as suggested in the diagram: all components should work together for the recovery of the patient, preventing an unnecessarily complex combination of platforms and services.

Figure 3: Consumer needs and early detection COVID-19 health ecosystems

Such a healthcare ecosystem will not be infallible in that it won't catch/detect everything. But it would clearly offer far greater value to what's currently in place.

At the very heart of a data-driven healthcare ecosystem must be the wellbeing of both individual and society.
Evangelos Avramakis, Head Digital Ecosystems R&D, Swiss Re Institute

The current fractured state of healthcare apps

At the moment, many COVID-19-specific symptom tracker solutions are already on the market, but they are being offered by different stakeholders with little integration, including academic institutions like Stanford University, private mega-companies like Apple and government agencies like the British National Healthcare Service (NHS). Other already-existing wearable tracking companies, like those specialising in health or fertility monitoring, are adjusting the technology they already have to monitor similar early indicators like basal temperature. But it's not just about tracking in and of itself: like wearables that measure the amount of steps an individual takes during the day, data can influence behaviour. In Figure 4 we see the basic concept of wearable-enabled early detection and how wearables can be used, not just to track, but also to influence behaviour.

Figure 4: Basic concept of wearable enabled early detection

Finally, less widespread products like thermal eyeglasses could help individuals detect the temperature of groups of up to 200 people from three metres away (Techcrunch, 2020).

The problem with all these different developments – and the rapid pace at which they are evolving – is that they exist in siloes and offer services on an individual basis. Unlike general health tracking, for most people, judging who to trust on grave matters such as COVID-19, is a difficult task for the average individual. Apple and Google have tried to make this easier by removing any apps from their respective stores that are not from official healthcare sources, but due to the global open and rapid nature of app development, this has been difficult to enforce thus far (Osborne, 2020).

Data privacy challenge vs. the collapse of the healthcare system and population safety

These apps and technologies would require the input and sharing of data to increase efficiencies across platforms to create ecosystems. People have given up a multitude of freedoms in order to curb the spread of the virus. As mentioned above, the economic cost has been truly staggering – in the UK it is predicted that the economy will shrink by up to 35%, outdoing the Great Depression. In many countries, people have found themselves unemployed almost overnight and now face increasing reliance on the government for assistance. Populations have seen a curtailing of their freedoms not previously known – especially in the West – in peacetime. This leads to the essential question – how much privacy people would be willing to exchange in order to improve their financial condition and see a return of some of their personal freedoms?

Figure 5: How countries use data to combat COVID-19 (selection)

By using targeted measures that are based on the data collected, such as pointed isolations and quarantines for specific affected people, countries could conceivably ease wide-ranging measures like full shutdowns and lockdowns.

Yet, for such a data-driven health ecosystem to deliver rapid actionable services, many countries would need to rethink and experience a cultural shift around data privacy. Intelligence gathering actions, such as contact tracing, require people to acquiesce to sharing access to their movements in a way that they haven't consciously done before. Although people may suspect they are already being tracked and monitored by various companies and devices despite privacy controls, seeing the real- time mapping of those they have even the most casual contact with may be a level too far for some people to accept, especially when that mapping is then submitted for analysis to a third party.

It is clear – the lockdowns and less stringent shutdowns have had far-reaching consequences. Beyond the resulting economic toll, they have cost people time, security and even their safety: Rates of domestic violence have shot up as a result of restricted movement (Taub, 2020). Calls to mental health hotlines have also increased as people struggle with isolation and resulting depression and other mental illnesses that may be exacerbated by loneliness and loss of social support systems. On a less dramatic, but still significant level, people have missed major lifecycle events, with weddings, major birthday celebrations and graduation events that have been postponed and cancelled. Furthermore, the economic toll is projected to take years to undo; industries have collapsed, small firms struggle to survive.

Perhaps the collectivist ideals that have made adhering to quarantine possible extend to an acceptance of more aggressive data collection and population tracking. However, it is one thing to stay home in the best interests of your neighbour. It is another thing to allow a third- party access to a list of those people that an individual interacts with throughout a given day. What we do know is that there is a growing need for healthcare ecosystems to be developed further in order to fight the spread of COVID-19 while resuming some semblance of "normal life" prior to the development of a vaccine, which is uncertain in terms of its timeline and development. No solution is without its drawbacks, and as a society, we need to have a public discussion about the ensuing privacy trade-off.

References

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A. Mckenzie (2018) "Train company introduces a system to find empty seats", mechtraveller.com, 9 Nov 2018, https://mechtraveller.com/2018/11/train-company-introduces-a-system-to-find-empty-seats/

C. Osborne (2020) "Apple, Google reject coronavirus apps not developed by official sources", zdnet.com, 6 March 2020, https://www.zdnet.com/article/apple-google-reject-coronavirus-apps-not-from-official-sources/

Stanford Medicine (2020) Stanford Medicine COVID-19 Guide for First Responders and Essential Workers, Stanford Medicine, 2020

A. Taub (2020) "A New Covid-19 Crisis: Domestic Abuse Rises Worldwide," nytimes.com, 6 April 2020, https://www.nytimes.com/2020/04/06/world/coronavirus-domestic-violence.html

WHO (2020) "Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected", 13 March 2020, https://apps.who.int/iris/bitstream/handle/10665/331446/WHO-2019-nCoV-clinical-2020.4-eng.pdf

Wikipedia (2020) "Give me liberty, or give me death!" wikipedia.org, 11 May 2020, https://en.wikipedia.org/wiki/Give_me_liberty,_or_give_me_death!

C. Zick (2020) "Privacy and Covid-19 Contact Tracing – Lessons From South Korea?" securityprivacyandthelaw.com, 25 April 2020, https://www.securityprivacyandthelaw.com/2020/04/privacy-and-covid-19-contact-tracing-lessons-from-south-korea/

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