RadinPh.D., is an epidemiologist at the Scripps Research Translational Institute in La Jolla and lives in Williamsburg, Virginia. Quer, Ph.D., is the director of artificial intelligence at the Scripps Research Translational Institute and lives in San Diego. Foschini, Ph.D., is the chief data scientist at Evidation Health and lives in Santa Barbara.
In his recent State of the Union address, President Joe Biden announced that rapid COVID-19 tests and free treatments would be available soon in pharmacies across the country. However, having tests available and leveraging digital health technology at home would be even better. Individuals who are sick and contagious shouldn’t have to leave home to be diagnosed or treated.
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In early January, the government did take steps in this direction by offering free COVID-19 tests to every household in the United States by mail. This was a start to delivering affordable testing that can be done anytime and anywhere, but the testing supply was greatly outpaced by demand. Society got a very fast lesson on the value of guidance on how best to use these tests, not just to identify infection, but also to get back to normalcy.
Digital health technology could have reduced the societal burden of COVID-19 had more people been open to the possibilities of leveraging it sooner. Health technology could and can still help inform the optimal use of limited test supplies by identifying specific individuals and periods of highest risk. Here are some scenarios:
In the last two years, most of us have wondered whether that sore throat, the sniffles or that persistent cough were actually COVID-19. We wondered: Did it finally get me? Or is this just allergies or another respiratory infection?
While none are perfect, many algorithms have been developed to help inform the probability of COVID-19 based on symptoms and demographics. An app-based study demonstrated that loss of taste and smell, combined with other symptoms, could help identify COVID-19 versus other respiratory infections. Wearable technology can also supplement symptom trackers and detect changes in body metrics most likely to indicate an infection, even before you are sick. While these tools cannot accurately diagnose different respiratory viral infections, they can help inform the likelihood of COVID-19. Ultimately, they can help individuals find rapid tests, and, if needed, guide the quarantine process, even remind individuals to test at the best time to detect infection.
As Omicron retreats and schools and social events reopen, tests can enable us to safely expand our worlds. Beyond wearables, we have other ways to learn whether we are at higher risk of having been exposed. Exposure notification systems, which have shown effectiveness in mitigating the virus spread in the United Kingdom, may identify recent exposure. In combination with wearables, they can also guide reporting results back to the system upon confirmation, helping provide more accurate information and waging the battle against misinformation.
Intriguingly, novel data streams – from wastewater surveillance, internet search terms, smart devices or fever maps – can also help identify community outbreaks faster. Using these technologies could inform the likelihood of infection at a local level to preserve limited testing and public health resources.
In the future, when there may be an abundance of tests available at low cost, frequent and periodic screening remains the best option for early detection of the virus and preventing its spread. In the early days of the pandemic, many US college campuses, such as UC San Diego and its Return to Learn program, required biweekly testing for all students and staff. These programs are highly effective, allowing early identification of positive cases, but they are costly and may be a burden for the individual. Wearable technology adoption could help direct testing towards individuals in whom the probability of infection is highest.
Rapid tests have a shelf life of six to 12 months. Balancing the most optimal time to use them, while ensuring individuals have one at hand if they develop symptoms or are notified of exposure, is challenging. It is especially challenging for large families who may need to ration usage based on household characteristics of who has the greatest risk exposure or highest risk of poor outcomes if infected. Technology has the potential to augment public health resources by providing real-time information, facilitating faster uptake of all public health tools, such as masking, staying at home when someone is sick or when sensor data begins to deviate from normal, and avoiding indoor gatherings when cases are surging in the community.
The COVID-19 pandemic has provided an opportunity for technology companies and device manufacturers to coordinate with public health officials to introduce a new era of precision public health that is not only innovative, but also inclusive and can help mitigate any inequities created by the digital divide .
This essay is in the print edition of The San Diego Union-Tribune on March 20, 2022, with the headline, Digital health technology will change the future