INTRODUCTION:

COVID-19, the 21st-century pandemic caused by the novel Coronavirus (SARS-Cov-2) originated from Wuhan, China¹. The infectious disease spreads by air droplets and by contact with surfaces contaminated by the virus². The World Health Organization (WHO) declared the disease as a Public Health Emergency of International Concern (PHEIC) which emphasized the responsibility of public and health care to prevent transmission of infection³.

At the time of writing this paper in October 2020, COVID-19 has caused over one million and one hundred thousand deaths and the total number of cases was approaching forty million⁴. The worst affected countries were the USA, India, and Brazil topping the chart⁴. The European region, which was believed to be the most developed and capable of handling the pandemic, too was affected and experienced more than one wave of the infection. The variability in the cases among the regions could be attributed to the response of the nation in controlling the spread of the disease and the treatment strategies¹. To date, no treatment is deemed to be the most effective and no prophylaxis is available. Almost every country in the world has adopted the ‘prevention is better than cure’ strategy in handling the pandemic. The strategy includes practicing hygiene by frequent sanitizing of hands, using face masks and other necessary Personal Protective Equipment (PPE), implementing nationwide lockdown measures and restriction of international travel⁵.

The coronavirus has exposed the vulnerability of developing the disease among humans and has shown the world that the healthcare system is not ready to face the pandemic. Though research is being carried out around the world, the knowledge on the novel coronavirus is also acquired from the previous researches showing that the new coronavirus having similar properties to the Middle East Respiratory Syndrome virus (MERS)⁶.

A few occurrences of the epidemic were observed in recent years namely Severe Acute Respiratory Syndrome (SARS), MERS, Ebola, and Zika virus⁶. Though the epidemics were confined to certain regions of the world, it captured global attention and attracted a unified response in the mitigation of the diseases. The occurrence of a pandemic was around a century back when the Spanish flu occurred in 1920.

The Swine flu pandemic of the year 2009 also manifested from common cold to severe respiratory failure. This ‘H1N1 influenza A’ infection was effectively controlled including vaccination and antiviral treatment⁷. Further educating public and health professionals played major role in the preventive measures of the disease^8,9.MERS caused by corona virus was identified in 2012, in Saudi Arabia which was found to have spread from the camels, which were identified as a reservoir and an animal source to human¹⁰.

The difference between the recent epidemics and the Spanish flu pandemic of the 20^th century and the current 21^st century pandemic caused by the novel Coronavirus is that it occurred in a time where the medical technologies are at the most advanced period¹¹. The healthcare experts, for a long period of time, believed that the world has never been ready to face a global pandemic or anything of its scale due to the availability of advanced technologies in the medical field and in the field of molecular research¹¹. The pharmaceutical technologies have been rapidly developing in recent years in an accelerated phase allowing the development and production of numerous medications that help in the creation of the latest treatment methods¹¹.

The latest technologies developed in the field of medicine is aimed at understanding the clinical picture of diseases to aid in the early diagnosis and monitoring the treatment. Such technologies use models created using Artificial Intelligence (AI) and the data collected from the population in clinical and non-clinical settings¹². Data from clinical settings include results from demographics, vitals, laboratory tests, images from radiological testing, such as X-Ray, CT, MRI, and ultrasound (US), treatment strategy, and outcome. Also, electronic gadgets that are commercially available to the population such as wearable smartwatches and Fitbit™ collect health data like heartbeats/ rate, physical activity over the course of days contribute to the data collected outside the clinical settings¹³.

Countries depend on the information shared by other nations about the treatment modalities and outcomes of the strategies adopted to tackle the pandemic⁵. The acquired knowledge is used to develop new strategies or to update the existing protocols in fighting the infection⁴. The knowledge gained is made available to international health authorities and other experts in the field of health including governmental capacity to make decisions appropriate to the country's performance in COVID-19 response⁵. The research on the Coronavirus is targeted towards understanding its genomic structure and the results which were made available is used as the basis for molecular diagnosis of COVID-19, which is done by a rapid test where the presence of the SARS-CoV-2 genome is tested^6,14,15.

This article tries to capture the use of technology in fighting the pandemic at three different points of time with respect to the disease process, namely, the prevention, diagnosis, and treatment of the disease. The three points of time classified doesn’t necessarily follow linearity in the occurrence, and is merely done for the ease of classifying the technologies predominantly used at that point of time.

MATERIAL AND METHODS:

The articles that were used in writing this paper were selected based on the recent publication date and on the subject of the novel Coronavirus from PubMed and SCOPUS databases. The articles referred in this paper were found by using the Boolean search method and the search keywords were ‘COVID-19’, ‘digital’, ‘technology’, ‘coronavirus’, ‘molecular’, ‘application’, and ‘data’. Articles that included a description of the clinical picture of the coronavirus and treatment methodology were also referred to maximize the understanding of the use of technologies and equipment in a clinical setting.

DISCUSSION:

Countries fighting the pandemic prioritize their resources in prevention strategies by countrywide public education through the mass media and promoting the hygiene practices. Though following preventive measures prove to be effective in controlling the spread of COVID-19, it doesn’t fully protect the population from contracting the infection.

The issue in identifying the infected cases arises when the disease manifests without any symptoms. The following strategy involves extensive screening and testing the population to isolate the suspected cases. As soon as a case is confirmed of COVID-19, the management of the disease takes place in a controlled environment with all necessary precautions¹⁶. Figure 1 outlines the application of technology and tools in COVID-19 response with the issues related to the application of technology.

Prevention:

1 Personal Protective Equipment (PPE):

As soon as the infectious disease caused by the novel coronavirus was brought to the light by the media and health authorities, one of the foremost strategies endorsed by the World Health Organization (WHO) and other international health agencies was to keep personal hygiene. The use of PPE was predominantly seen among workplaces where handling biological and chemically hazardous materials was required, for example, hospitals, laboratories, and power plants. The use of PPE as a protective measure was recommended for the pandemic. Both the general public and health care workers were recommended to use PPE of different levels, that is, wearing a surgical mask versus wearing a full-body Hazmat suit wherever necessary¹⁷. The healthcare workers, mainly doctors and nurses working closely with COVID positive patients are recommended to wear specialist Filtering Face piece (FFP) face masks that are effective in filtering from 80% to 99% of particles, for comparison N95 and N100 masks filter out 95% and 99.97% of particles more than 0.3 micrometers¹⁸.

2 Social distancing:

When the world realized the presence of a rapidly spreading infection of novel Coronavirus caused by air droplets, physical distancing was recommended worldwide and limit the gathering of population¹⁹. The term social distancing has been used widely to iterate the recommendation of keeping a distance from each other. Many experts believe that the term ‘social distancing’ was inappropriately used and the suggested recommendation was merely to keep distance physically and not literal social distance or disconnect from the community²⁰.

3 Screening:

As soon as the nationwide lockdowns were implemented all over the world, and recommendation of using PPE and following social distancing, the health authorities turned towards screening the population on a large scale^1,21^. Many countries took the recommendation of screening their population to a level at which they intended to screen everyone in the country. While some countries with limited resources only screened populations that expressed symptoms of COVID-19. Though strict lockdowns were implemented, many essential businesses were allowed to function following the guidelines drafted for the country adapted from the recommendations made by international health authorities such as the WHO and National Center for Disease Control and Prevention of the United States (NCDCP-US)^5,22.

4 Contact-tracing:

Contact tracing is one of the most useful methods in identifying the population who had contact with a positive case of a disease. Primarily used in an epidemic situation, it has proved to be useful in the ongoing pandemic, As it could be upscaled without losing its efficiency in its fundamental property of identifying individuals, who were in contact with a confirmed case. According to the guidelines by the WHO, contact-tracing is done in three steps: identifying contact, listing of contact, and follow-up of the contacts¹⁹.

5 Prediction modelling:

With all the collected data, countries develop models that can predict the trends in the cases of Coronavirus in the country and worldwide. Many models have proven to successfully predict the trends in the number of cases and of the second wave of an increased number of diagnosed cases²³.

Diagnosis:

The diagnosis is usually made from the testing of individuals who express COVID-19 symptoms. The varying manifestations in COVID-19 include fever, cough, abdominal symptoms, and skin manifestations to the most severe respiratory failure. The skin manifestations were also observed in chronic obstructive pulmonary diseases (COPD) with varied severity utilized the technology of skin biophysical parameters as biomarkers²⁴. Studies done in England found that Gas Chromatography-Ion mobility Spectrometry (GC-IMS) can be employed to analyse breath biomarkers in COVID-19 patients, where aldehydes, ketones, and methanol are indicative of COVID infection²⁵.

The suspected cases are isolated as soon as possible and tested for the disease by the priority in regard to the severity of the displayed symptoms. In the early stages, the suspected individuals and in the acute stage of the disease could be tested for viral nucleic acid, while testing for antibodies prove to be more efficient in the diagnosis of recurrence of infection in the community.

The technologies included in the diagnosis of COVID-19 comprise varied testing opportunities and include both molecular and immunological assays. The molecular testing includes Next‐Generation Sequencing (NGS), Reverse Transcription-Polymerase Chain Reaction (RT‐PCR), and Loop‐Mediated Isothermal Amplification (LAMP), which are used to identify the presence of viral nucleic acids¹⁰. The immunological testing includes Enzyme‐Linked Immunosorbent Assay (ELISA), Chemiluminescence Enzyme Immunoassay (CLIA), and Lateral Flow Immunochromatographic Assay (LFIA), which are used to identify the presence of antibodies¹⁰. Furthermore, recognizing the acoustic signal patterns from the breathing of COVID-19 patients by smartphone and using in the generation of an AI to identify the infected population who express changes in breathing patterns was suggested as a tool for self-diagnosis²⁶.

1 Molecular testing

The NGS testing incorporating metagenomics was applied at the very initial stage of the pandemic when the technique was used to isolate the novel Coronavirus and conclude that the virus was 79.6% similar to the SARS-CoV which was responsible for the SARS epidemic²⁷. A quick COVID-19 diagnosis can be done using RT-PCR, where this method involves transcribing the RNA into DNA and identifying the complementary sequence of the viral genome. RT-PCR has a high specificity and is considered to be the current gold standard in diagnosing COVID-19^14,28. Finally, the LAMP method is used for a quick and cheap diagnosis of COVID-19, where the method involves heating and visualization of the amplified DNA for colorimetric change²⁹.

2 Immunological testing

Immunologic tests are done to evaluate the COVID-19 status of patients who are found to have antibodies against the disease. ELISA is an easy and cost-effective method in diagnosing Coronavirus where the binding of an antibody-enzyme to an antigen is used to detect the presence of antibody-antigen complex, after removing the enzyme by a substrate which results in a change of color^14,29. CLIA uses luminescence and a different substrate to detect the binding of the antibody, nevertheless, the method is very similar to the method of testing previously explained.¹⁵ LFIA is another quick testing method which is the preferred immunological test done for quick diagnosis³⁰.

3 Radio-imaging

Along with the aforementioned molecular and immunological testing, radio-imaging techniques are also used in the diagnosis and tracking of the effectiveness of the treatment of COVID-19. The commonly used imaging techniques in COVID diagnosis and management are X-ray, CT, MRI, and ultrasound (US) examination³¹. The images generated by the radiological imaging are fed up into the AI-generated models and generated applications that can be used for early diagnosis of COVID-19. The primary intention of AI-generated models was for the differential diagnosis between pneumonia induced by the Influenza-A virus and Coronavirus³². For this purpose, CT and X-ray images were used to develop a model that was around 90% accurate in differentiating COVID from seasonal influenza and aid in quick diagnosis in the early and acute stages of the disease before the confirmation of diagnosis using the gold standard test.³²

Treatment:

A wide spectrum of technology is incorporated in both inpatient care and outpatient care of COVID patients. Even before the pandemic situation, a computerized database has been maintained at the national, or regional, or hospital level to hold patient records and aid in the treatment process. The continuous data collected on the COVID status of confirmed cases prove to be the most reliable tool in the management strategy.

1 In-patient care:

The inpatient care of COVID treatment involves multiple specialties. Since most of the clinical manifestations among COVID cases are seen in the respiratory system, maintaining the proper gaseous exchange and the lung function were the most required in the management of the cases. Patients affected with Coronavirus develop type1 respiratory failure in serious conditions and require mechanical ventilation¹⁷ The need of increasing nursing skills and knowledge is mandatory to handle number of patients with prolonged ventilation in this global pandemic situation³³.

Though Continuous Positive Airway Pressure (CPAP) is usually employed in respiratory failure, it doesn’t help much in the management of COVID patient¹⁷. Another feature of COVID-19 is the development of ARDS and requires extensive clinical management. Extra Corporeal Membrane Oxygenation or popularly known as ECMO has been considered for patients with ARDS who exhibit refractory hypoxemia and the indications for patients with COVID don't differ¹⁷. Ozone therapy, a relatively less employed treatment option that has potential benefit in COVID-19 treatment was found.³⁴ The ozone therapy by O₃ is believed to reduce inflammatory processes and improve immunity by cytokine and interferon modulation³⁴. The Renin-Angiotensin-Aldosterone pathway do not only produce vasoconstriction, but also changes in endothelium, inflammation processes, and in systemic coagulation, which all come into play during infection with COVID-19³⁵. Concurrently, hospitals and medical facilities that hold COVID-19 patients maintain negative pressure in the ward as it is known to limit the spread of coronavirus through ventilation²¹.

2 Remote care:

The concept of remote care is not new in the medical field, and recently it has been widely accepted and sought after during this pandemic as it is proven to limit the exposure of the patients and also the healthcare professionals to the cases. Remote care is usually used for contagious diseases particularly in Tuberculosis management where the healthcare professionals who are in close range to the patients and are at higher risk^[³⁶^]. Some countries deliver health services partnered with private companies and pharmacies for the delivery of medicines in the time of the pandemic²³.

As the children and older are the most affected by COVID infection the burden can be reduced by increasing awareness of preventive measures. The mothers can be educated to improve their knowledge towards early detection of acute respiratory infection of under five-year old children³⁷.

In older COVID patients, the critical care includes the early identification of complications such as venous thromboembolism (VTE) associated with respiratory failure. Proper nursing care at tertiary care hospitals by efficient early risk assessment of VTE by health professional including nurses may prevent COVID mortality³⁸.

Issues related to the application of technology:

It is evident that technology is very useful in the pandemic at multiple time points of the COVID response, but it also brings its fair share of difficulties during its process of implementation and maintaining the application of technology in this situation. The following have been identified as issues that may question the efficient use of technology.

1 Social disparity:

Social disparity can be defined as the disparity among the population of a country with respect to their Socioeconomic Status (SES) in access to healthcare services, education, and income. A country will have groups of populations that differ by their SES which are the predictors of their health behavior and health status. A disparity occurs when the higher socioeconomic status of the population has an advantage of the better health status through easy access to healthcare and leaving the vulnerable population at risk of poor health status due to inaccess to the same healthcare services. The social disparity has had its effect on the COVID response, as the lower SES group suffers from higher infection rate, and improper timely intervention when compared to the higher counterpart population³⁹.

2 Management of medical supplies:

With the sudden increase in demand for PPE, testing kits, and other medical technologies for the COVID response, the medical industries have increased their production⁴⁰. During the initial period of the pandemic when the severity of the situation and the expected demand was not assessed, the sudden demand for medical supplies induced an increase in the retail price of medical goods and illegal hoarding of necessary supplies that lead to inefficient utilization of the available medicines and medical supplies.

3 Data/identity protection:

To have a proper functioning screening and contact tracing, information related to an individual’s recent activities are collected worldwide by the respective health authorities. Collecting sensitive information from an individual always possess a risk of data protection, since the pandemic situation requires sharing of sensitive information, health status, recently traveled places within the country and across borders, a lot of information has been acquired by the health authorities over a period of eight months since the lockdown were implemented vigorously worldwide⁴¹. Many countries store the collected data in a centralized database and limit access to the only required health authorities⁴¹.

4 Data sharing and communication:

The acquired data on the disease and the latest information on the cases and prevention strategies are needed to be made available to the concerned authorities of the countries and to the general population. The WHO has been actively involved in disseminating updated information regarding COVID-19 through its social media accounts and messaging services. Some countries follow the steps of WHO and communicate directly with their citizens through mass media⁴². The data and knowledge acquired from the experience with Coronavirus are made available for other countries to adapt one’s COVID response and aid in implementing the services and the reallocating resources^23,41.

5 Misinformation:

It is not new that rumors or word by mouth lead to misinformation about medical procedures. With the availability of easy access to the internet and the availability of abundant unverified sources online, the misinformation has resulted in split opinions among various groups of the population. Even the most developed countries suffer from such misinformation on COVID-19⁴². Many countries have created special departments within the government or within the healthcare ministry to deliver accurate and verified information to the population and get in direct communication with the population through hotlines for COVID-19 response⁴². Some health care experts also believe improving transparency of the decisions will improve the medical services⁴².

CONCLUSION:

The ongoing pandemic has provided opportunities for expansion of the use of technology in medical services. The gained experience and the collected data on the health behavior of the population will allow the field of medical sciences to improve the current practices and push the innovation in the field to its maximum. Though the use of technology in healthcare could be limited by the acceptance of it by the healthcare professionals and the general population, who are the recipient of the services, the field of medicine is evolving in providing the best care to the patients.

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

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Received on 23.10.2020 Modified on 27.01.2020

Research J. Pharm. and Tech. 2021; 14(9):4808-4814.

DOI: 10.52711/0974-360X.2021.00836