When an outbreak of severe acute respiratory syndrome (SARS) claimed 33 lives in Singapore in 2003, it was a reminder that, as a major trade and travel hub, the country is vulnerable to pandemics. Since then, there have been more scares: a Zika virus outbreak in 2016, a deadly diphtheria case, yellow fever and tuberculosis, and well-researched pathogens such as influenza. All these health scares underscore the importance of taking firm steps to curb the spread of disease.
Infectious diseases are spread through three main vectors: air, water and touch, and they sometimes lead to epidemics. Drinking contaminated water is estimated to be the cause of more than 500,000 deaths a year, according to the World Health Organization, and can transmit epidemics such as dysentery, cholera, typhoid and polio.
Some infectious agents can be spread through airborne transmission, such as tuberculosis and meningococcal disease, as well as influenza. Person-to-person or contact transmission allows infectious diseases such as influenza and many forms of pneumonia to spread quickly. Other deadly illnesses, such as Ebola, are spread by touching the blood or bodily fluids of a person who is sick with or has died from the condition. These different vectors and the risks associated with contamination require that officials managing disease surveillance have extensive knowledge about both the disease and how to contain it.
Faced with the potentially devastating impact of pandemics, the Singapore Ministry of Health (MoH) wants greater power to address public health threats, including better pattern-tracking to help prevent diseases from spreading and more efficient quarantine methods. At the same time, however, the government wants to avoid the panic that the threat of epidemics can create, such as healthy patients rushing to have vaccinations after receiving incorrect information. Without the ability to control and contain information, there is a serious risk that hospitals and other healthcare centers will run out of vaccines if and when an outbreak occurs.
The ability to control and track cases, as well as potential carriers of communicable disease, is therefore paramount and needs to be directed through the appropriate channels, such as Singapore’s Communicable Disease Centre (CDC), MoH and the country’s three integrated public health clusters.
If a threat is observed, early warning can prevent a minor outbreak from becoming a major public health threat. To successfully prevent a health crisis, health and government authorities need to be able to identify a patient with a serious infectious disease, quarantine and treat that individual, and track their prognosis post- discharge. Friends, relatives and coworkers who have come into contact with that individual also need to be identified and tracked.
In addition, officials will need to be alert to health threats more generally. For example, fears over the spread of the Zika virus during and after the 2016 Summer Olympics in Rio de Janeiro had officials on red alert across the globe, and in the wake of the 2018 football World Cup in Russia, health officials are using horizon scanning to be on the lookout for any signs of disease outbreak globally.
Thankfully, the digital innovations that are changing so many other aspects of our lives can play a role in preparing for and managing potential crises. In the digitally connected era, real-time situational intelligence enables authorities to mitigate and contend with a potential epidemic before it becomes a public health and economic threat.
Disrupting the spread of disease
How, then, do island nations such as Singapore begin the process of digital mitigation? As a tropical region, Singapore can plan for some potential outbreaks, such as dengue fever and other seasonal diseases, by tracking patterns and ensuring that the right resources are available where they are needed. Another important step is to track patients who develop tell-tale symptoms of infectious disease and, where relevant, issue an early warning before the disease spreads.
This is where next-generation technologies truly come into their own. Artificial intelligence (AI), machine learning, robotics, internet of things (IoT) devices and other monitoring devices (including those used by individuals in their day-to-day lives — such as Fitbits and heart monitors), video analytics and geofencing — all play an invaluable role in monitoring, tracking and managing infectious disease to prevent an outbreak.
Achieving “diagnosis by digital device” begins with a likelihood assessment to determine whether an individual may have come into contact with an infectious disease. From there, AI-led technologies will alert government officials to monitor that person, as well as track and test anyone the individual has interacted with in his or her day-to-day life. If that person tests positive for an infectious disease, video analytics can then be used to find and quarantine the individual.
An important part of the process will be to geofence infected individuals using ankle or wrist bracelets and IoT devices to track their movements and prevent these individuals from leaving a quarantined area. A device-removal sensor can alert those monitoring the patient to ensure that the device is not taken off.
Once treatment begins, remote robotics, AI and machine learning will again be used to determine how well the patient responds to medication, the dosage needed and so on. Since the patient may not be able to visit the doctor, mixed reality can be used to connect the patient and doctor remotely and enable the doctor to provide specific instructions.
Those instructions may be too complex for a non-healthcare professional — for example, where to place one’s hand for analysis or how to take a pulse — and simple diagrams or spoken instructions might not be sufficient. That’s where remote robotics and mixed reality could allow for very specific, clear instructions to be conveyed.
Often it’s not only the patients who are potentially contagious but also their day-to-day items, such as clothing, bedding and other things. IoT devices can be deployed to tag and track the items through to their appropriate disposal.
Once a patient has shown signs of recovery, the rehabilitation phase begins. Unfortunately, the chance of relapse from serious communicable diseases is high. During the rehabilitation phase, the patient’s daily vitals are taken and, again using IoT devices and AI, the likelihood of relapse is assessed through continuous reporting of symptoms. AI and machine learning also will be used to determine the potential cause of the relapse, such as climatic or environmental factors.
Being on the alert for these possibilities and having digital innovation at the ready to quickly address any potential outbreak will help health authorities and government officials respond promptly to any outbreak and help prevent a pandemic.