COVID-19: A Worldwide Battle

How are countries around the world treating patients and preventing transmission of the virus?

There are currently over 68 million cases and 1.5 million deaths attributed to the coronavirus globally. (Stock photo.)

There are currently over 68 million cases and 1.5 million deaths attributed to the coronavirus globally. (Stock photo.)

Technology plays a vital role in our society. With this ongoing struggle against the COVID-19 pandemic, it has become more important than ever. 

According to a World Economic Forum and Boston Consulting Group analysis, 25 percent of solutions against the virus focus on detection and containment, 20 percent focus on helping health care providers, and 21 percent focus on addressing the new economic conditions. 

Countries worldwide are using innovative ways to keep up their resiliency to combat this global crisis. While some of these technological solutions are new devices, others are old technologies transformed for new purposes. 

South Korea

South Korea, which had one of the largest initial outbreaks outside of China, has been a leader in controlling the spread of the virus and helping patients recover quickly—all without the need to impose a nationwide lockdown. 

The country began investing in health care, especially in rural and poor communities, during the 1950s. By the 1960s, the South Korean government introduced incentives so that doctors were available everywhere. In 1977, companies had to buy into a compulsory health insurance system, which became a major source of funding for the country’s health system. 

Today, South Korea is considered to have one of the best health care systems due to its vast amount of health data, universal health coverage and equitable access. The country’s health care system focuses on digital methods, including big data, Health IT, and artificial intelligence (AI). 

COVID-19 is accelerating the adoption of digital health technology in South Korea. (Image courtesy of Global Data.)

COVID-19 is accelerating the adoption of digital health technology in South Korea. (Image courtesy of Global Data.)

In terms of the coronavirus pandemic, South Korean government officials met with several medical companies to create test kits within just one week after the country’s first case was diagnosed. By the second week, the companies had shipped thousands of test kits, even though cases were only in the double digits. In fact, the country has tested more people than any other country (40 times more than the United States), and isolated or treated people diagnosed with the virus far more quickly. 

To detect and isolate individuals, South Korea has focused on contact tracing. Once someone tests positive, health workers retrace the patient’s movement to test and isolate anyone who has been in contact with the patient and shows symptoms too. Staff uses security camera footage, credit card records, as well as GPS data from the patient’s cars and cell phones to complete the process. 

An electronic health record is utilized to manage and monitor all medical records and systematically manage symptoms and signs related to COVID-19 in hospital staff. The country also employs a rapid response system to monitor the status of all COVID-19 patients at a glance without direct physical contact, allowing staff to intervene if a patient’s health worsens. A 55-inch touch screen monitor called BESTBoard tracks the patient’s heart rate, respiratory rate, systolic blood pressure, oxygen saturation and urine output.  

A COVID-19 patient arrives at a hospital in South Korea. (Image courtesy of Wang Jingqiang/Xinhua/Redux.)

A COVID-19 patient arrives at a hospital in South Korea. (Image courtesy of Wang Jingqiang/Xinhua/Redux.)

The country has also set up community recovery centers to treat patients with mild COVID-19 symptoms. Primary care physicians help patients and check for deteriorating signs in community recovery centers (CRCs).

South Korea has put additional effort into website advertising, mass messaging and apps to convey cases in specific districts as well as states where those infected with COVID-19 have traveled. 

Taiwan

With its population of 23.8 million, it is surprising that Taiwan was not as negatively affected by the virus as countries like Canada. Currently, the country has around 718 cases and seven deaths, even though it is close to the virus epicenter. 

Government officials began to screen arrivals from Wuhan right when the first reports of the virus surfaced. People with even mild symptoms were placed in quarantine. In the first month, the country’s Central Epidemic Command Center—which worked to control the severe acute respiratory syndrome (SARS) outbreak in 2003—started to impose restrictions to manage the pandemic. 

Taiwan was also the first country to ban visitors from Wuhan and impose home quarantines for all residents returning from the location.

Like South Korea, Taiwan also focused on contact tracing and testing to control the cases. Its Centers for Disease Control (CDC) worked to develop test kits and expand centers via the country’s national laboratory diagnostic network. With the help of 37 laboratories, the country aimed to perform 3,900 tests per day.  

A hospital in Taiwan. (Image courtesy of CNA.)

A hospital in Taiwan. (Image courtesy of CNA.)

Taiwan’s hospitals were also built to have enough isolation rooms for confirmed and suspected cases. Staff implemented entrance control throughout the country’s hospitals. 

The country suspended mask exportation and engaged local companies in ramping up production as well as introducing a rationing system that prioritizes allocation to health care workers while allowing citizens to buy a capped number of masks per week. This ensured an adequate and affordable supply of face masks to protect both health care workers and citizens. 

Perhaps the most important element to Taiwan’s strategy is its National Health Insurance (NHI) system, which tracks patients’ travel histories and generates real-time alerts to facilitate early detection of cases. The real-time alert is based on a quick response (QR) code scanning and online reporting of travel history, contact history and health symptoms. 

People who are placed on home quarantine are subjected to phone monitoring to report their health status and ensure that they stay at home. Taiwan’s insurance system also enables citizens to receive insurance to cover their medical expenses. 

The NHI system includes sampling datasets for 99.6 percent of the Taiwanese population. It reports on disease-specific and population datasets, containing basic demographic information, disease diagnoses, prescriptions, operations and investigations. 

Government officials are also making mass calls to increase transparency by publicizing the locations of community transmitted cases so that citizens can avoid virus hotspots. 

Italy

Italy was one of the countries hardest hit by the pandemic. 

Partly to blame is the county’s widespread culture of defensive medicine. Italy’s approach to the pandemic was more reactive, in contrast to Taiwan’s and South Korea’s. The country tested fewer people at 826 people per million, which has led to over a million coronavirus cases since the start of the pandemic. 

Two intensive care professionals comfort each other at an Italian hospital. (Image courtesy of Paolo Miranda.)

Two intensive care professionals comfort each other at an Italian hospital. (Image courtesy of Paolo Miranda.)

To help decrease the number of infected individuals, the Italian government placed the entire country on  a total lockdown, which led to riots and further transmissions. 

During the lockdown, the Ministry of Innovation announced its initiative to create a multi-disciplinary task force, with scientists and technological experts tasked with finding a solution to containing the virus and enforcing measures during the pandemic. While many tech companies were already researching ways to track COVID-19 cases, such as using Facebook to follow people’s movements, the new task force would analyze ways to group data from Facebook’s GeoInsights portal. The announcement led to the creation of many apps, such as one that uses patient information to build a map of infected areas and store the information in a phone’s International Mobile Equipment Identity (IMEI) code and IP address. According to the Italian ministry, the projects would need government approval in order to abide by privacy regulations.

3D-printed valves. (Image courtesy of Michele Fain.)

3D-printed valves. (Image courtesy of Michele Fain.)

Italy soon ran out of beds in its intensive care units (ICUs), and hospitals tried to ration their limited resources around patients thereafter. They turned to 3D-printed parts to help create more inventory of equipment. Isinnova and Lonati designed and printed 100 life-saving respirator valves in 24 hours for a hospital that had run out of them. 

The government then looked to the creation of Italy’s Immuni COVID-19 contact tracing app, which allows a diagnosed individuals to enter their condition and other information into the app, and transmit that data to other devices nearby using Bluetooth signals. The app then notifies device owners that they may have been exposed to the virus, and what they should do about it. 

However, less than a quarter of Italians downloaded the app since much of the population does not trust their physicians due to their lack of transparency in explaining medical procedures prior to carrying them out. During the pandemic, physicians have had to cross this hurdle by providing more appropriate services and explaining the reasoning behind providing effective health care. 

India

In March 2020, the COVID-19 pandemic surged out of control in India, forcing the entire country to enter a strict lockdown. 

The country set up surveillance as well as testing and data management systems to control the spread of the virus. In the second most populated country in the world, testing and contact tracing were hard to manage. There has also been an underinvestment in public health in the country. 

Regardless, the pandemic sparked a wave of innovation in response to the urgency of the situation. Technologies ranged from robots that dispensed hand sanitizer and delivered public health messages about the virus to some that carried food and medicines within hospitals. 

Contact tracing apps were also vital in controlling transmission in the country. The Aarogya Setu app uses GPS as well as Bluetooth waves to inform people when they might have been in contact with an infected individual. The application programming interface assigns a random ID to each device every 10 to 20 minutes, so it cannot track the user’s location or personal information. However, the ID tracks if the device has been near an infected individual for longer than 15 minutes. If it has, the ID is added to a list of COVID-positive users. The person is then notified without revealing anyone’s location or identity. 

The Aarogya Setu app. (Image courtesy of Tech Crunch.)

The Aarogya Setu app. (Image courtesy of Tech Crunch.)

In response to the shortage of ventilators for critical care, startups such as Nocca Robotics, Aerobiosys Innovation, and AgVa Healthcare are developing affordable portable ventilators that can be deployed in rural areas. These ventilators provide respiratory support to patients by delivering high-flow warmed and humidified gases through a nasal interface. Each ventilator features an inbuild turbine and electronic FIO control. 

United States of America

The U.S. is one of the countries hardest hit by the COVID-19 pandemic, with over 15 million reported cases. 

However, the country was also one of the first to introduce contact tracing and send mobile notifications to individuals when they come into contact with an infected individual. Medical staff can then use the information to persuade those potentially infected to stay home. 

Researchers at Northwestern University and the University of Illinois have also created a device to collect and analyze data related to disease progression through a wearable patch. The patch can also track COVID-19 patients and monitor their respiratory activity. The device sits at the base of the throat and helps process data through machine learning.  

The patch is only slightly thicker than a bandage. (Image courtesy of Northwestern University).

The patch is only slightly thicker than a bandage. (Image courtesy of Northwestern University).

During this time of social distancing, the U.S. Food and Drug Administration and other clinical groups have been using virtual patients to obtain anatomical data and produce a mathematical model of an individual’s actual organs. Algorithms then work to generate a virtual organ that behaves like the real one. This helps to speed up results, mitigate risks, diagnose conditions and plan treatments. For example, HeartFlow Analysis, a cloud-based service, can help identify disease through CT images of a heart based on preprogrammed models of a normal heart. 

Intensive care staff across the country have been trying to find the perfect drugs to help COVID-19 patients. They found that remdesivir, dexamethasone and hydrocortisone can significantly reduce the virus’s death rate. As in much of the world, other equipment in the U.S. has also been taken into consideration to treat patients, such as ventilators. Ventilation can help deliver oxygen into the blood through high-flow oxygen therapy as well as CPAP machines.

Staff connect a mask that contains a high concentration of oxygen through a plastic reservoir bag. If a patient is still having trouble breathing, a specialist will reposition the patient to lie on their stomach and follow with ventilation that has more volume, pressure or frequency. If this is deemed to be insufficient, specialists will switch to bag-valve-mask ventilation, which involves inserting an endotracheal tube down the patient’s throat and using a mechanical ventilator to transmit oxygen directly to the patient’s lungs. 

Process of ventilation. (Image courtesy of HowStuffWorks.)

Process of ventilation. (Image courtesy of HowStuffWorks.)

Vaccines are the future of health care combating the pandemic. 

Multiple companies across the U.S. are producing microneedles, which prevent a person from feeling any pain by avoiding contact with nerve endings. The tip of the needles is the width of a human hair and can reach the epidermis, the second layer of skin. The syringes work to collect blood or measure the status of the patient’s health if combined with biosensors. Since they are not costly and do not require extensive training, they are perfect for use in rural areas.

Currently, there are two major COVID-19 vaccine candidates. Pfizer and BioNTech have developed BNT162b2, which is 95 percent effective. The American company utilizes a messenger ribonucleic acid (mRNA) immunotherapy process using a computational approach to create a unique bioinformatic profile of mutation patterns. In turn, this helps develop a drug candidate with mRNA particles for the immune system to grow resistance. Moderna’s mRNA-1273 vaccine creates an mRNA sequence using the company’s cloud-based Drug Design Studio that instructs the body to create the coronavirus spike protein. The protein will enable the immune system to recognize COVID-19 and learn how to make an antibody to fight it. 

Medical professionals around the world are at the forefront in the battle against the ongoing pandemic. Computing and technology, such as mechanical ventilators, apps, patient databases, AI, and supercomputers can fast-track the journey to a worldwide vaccine; however, they need to be operated by highly trained personnel, otherwise they could be deemed useless. Thus, we need to work together and unite to defeat the COVID crisis once and for all.