Health Surveillance Expected to Play Bigger Roles in Combating Future Pandemics

The COVID-19 virus continues to spread worldwide. Damaging our health and claiming lives of those weak, sick and old, the eerie virus exploits the human bonds to travel beyond our imagination. While EU and US are copying the tool-kits from Singapore and some other successful Asian models, we know every well that digital health surveillance also has a critical role to help more effectively contain the contagion.

COVID-19 Surveillance

We live in an age of the 4th Industrial Revolution. We are digital. Wherever we go and whatever we do, we leave behind digital breadcrumbs. Like it or not, digital is ubiquitous today. It forms the best conditions for health surveillance.

Surveillance technologies have already been playing their due role in fighting the COVID-19 pandemic. For instance, Israel's domestic intelligence agency, the Shin Bet, deployed a nationwide digital-surveillance program, using technology designed for counterterrorism, to locate people at risk of infection. The program uses cellphone data of people known to be infected to identify who else was close enough to catch the virus, according to a NYTimes report.

The NYTimes coverage also finds that authorities in some Asian countries have deployed similar surveillance methods and said they contributed to containing the virus. South Korea health authorities can sift through credit-card records, CCTV footage, mobile-phone location services, public transportation cards, and immigration records to pin down the travel histories of those infected or at risk.

China monitors individuals with data provided by telecom companies, the railway bureaus and airlines. Hong Kong monitors families quarantined at home with electronic wristbands. Taiwan of China tracks people who are under home quarantine using their mobile-phone signals.

Big Data and Presentation

Global community was literally caught by surprise and shock when the COVID-19 pandemic hit and spread worldwide at an unprecedented pace, scope and scale of impact. Nation after nation, region after region, adopts lockdown and social distancing while being wrought by overwhelmed medical services to serve those most in need - the severely and critically sickened.

What had happened? How could nations, rich and poor, be so ill prepared for such a pandemic? And very importantly, how can humanity become better equipped with resilience and capacity to prevent and control such public health shocks in the future?

"How the virus got out" appears a very good and timely starting point to trace back this journey. The digital NYTimes published a graphically animated big data-based story that brings us back to WHERE and WHEN the COVID-19 outbreak happened in Wuhan, China, and HOW the virus has travelled from the epic center throughout China and globally. This is the best digital presentation ever I had wished to see.

We now understand why lockdowns and social distancing is so critical in order to quickly flatten the curve and contain the spread, and why airlines are closing flights to and from certain countries and regions. At the end of the day, humans are social animals; we love moving around to see people and things and enjoy our lives. The COVID-19 virus has captured the human bonding opportunity and take advantage of that to spread, quickly.

"Social Distancing Scoreboard"

Tech companies and innovators in US are also rolling out similar tools and products as their peers in Israel and Asia, many of which have a more specifically focused purpose. Unacast, a start-up, has been collecting and analyzing phone GPS location data to generate a "Social Distancing Scoreboard", which grades county and county to understand residents' behavior changes at the current critical time of enforced social distancing and shelter-in-place. According to a Washington Post article, from March 20 to an average Friday, Washington, DC, gets an A on mass movements while Wyoming as an F.

The article says that Unacast’s location data comes from games, shopping and utility apps that tens of millions of Americans have installed on their phones - information the company normally analyzes for retailers, real estate firms and marketers. It’s part of a shadowy world of location tracking that consumers often have little idea is going on.

As we all know, Google also collects and shares where we go. The Google Maps app has included a live read of how busy popular destinations are, based on location data. Facebook’s Instagram, too, lets you see other people who’ve recently shared updates from places. Both tools are useful for anyone who wants to practice social distancing and avoid spaces that are busy for a jog or fresh air during shelter-in-place orders.

There’s no evidence that the U.S. government is using phones to enforce stay-at-home orders or track patients. But privacy is often the first civil right on the chopping block when public health and national security are at risk. Getting the balance right is hard, says the article.

AI, Deep Learning Algorithms

COVID-19 outbreak and pandemic provides computer and machine learning scientists a live case study to contribute to global fight of the pandemic, though we do not see those people on frontlines. They are creating virus data sets, focusing computing resources on the search for vaccines, tracking the virus’s spread, improving the distribution of critical health care supplies and facilitating online educational tools.

A Chinese social media group summarizes some of the work in progress by different companies and universities. Here are some examples:

• COVID-19 confirmed cases database: Google's Kaggle runs a daily update of confirmed cases, including such data items as age, location, when showing symptoms, when exposed, when admitted to hospital, etc.
• COVID-chestxray database: A Montreal University researcher has been collecting and publishing a few dozen CT scanning and patients' X-ray picture, collected from publicly available sources;
• Global Infection Location Map: Johns Hopkins University has set up a Compass, detailing global COVID-19 cases data, updated periodically, which provides a global perspective of the spread and fatalities. It is now using GitHub open source coding for self-copying and revision;
• Large-scale COVID-19 Open Database: A joint effort by Alan AI Institute, Chen-Zarkerberg Initiative (CZI), Georgetown University Center of Safety and Emerging Technologies (CSET), Microsoft, US NIH National Library of Medicine (NLM), and OSTP. It contains more than 29,000 academic papers related to COVID Pneumonia, coronavirus and COVID-19 virus groups;
• Regional resources website databases such as Beijing - https://data.beijing.gov.cn/; and Shandong - https://data.sd.gov.cn/;
• Some Papers around related algorithms, such as - 1) Radiology: AI-based COVID-19 synopsis accuracy evaluation; 2) Deep-learning quantitative study on lung infections from COVID-19 CT pictures;, by researchers from Shanghai; 3) Large-scale scanning of COVID-19 by categorizers of abnormal breathing modes by using deep learning; 4) Using deep learning to analyze CT pictures for automatic inspection and patient monitoring - some preliminary findings.

A New Normal

The 21st century proves to be a crisis-ridden century. Crisis, large and small, hits us in much increased frequency and intensity. The web of ecosystems is fraying. Climate change, an existential challenge, inundates our infrastructure, economy and social life, literally all year round now. Climate change is also a health crisis. Temperature and humidity change disrupts the normalcy of the web of fora and fauna and exposes humans to more kinds of virus outbreaks.

More than ever, humanity requires most effective surveillance in order to weather the crises and storms. Take a look at the sources of information and expertise the NYTimes article have used for the great presentation.

1. Travel patterns across China that track the movement of cell phones: based on data published by Baidu (Chinese search engine), and data from two Chinese telecoms published by Cao et al.;
2. Estimated size of early outbreak in Wuhan: Trevor Bedford of University of Washington, and Lauren Gardner of Johns Hopkins University;
3. Estimates of number of infected people who left Wuhan: Jeffrey Shaman of Columbia University;
4. Normal air travel patterns from Wuhan: 2019 data from OAG, and 2020 data from Cirium;
5. Case data: local government and health officials; Johns Hopkins University; National Health Commission of China; and WHO;
6. And some additional academic sources to support both data and analysis for the presentation.

A Much Enhanced Health Surveillance Future

We are learning some very important lessons from fighting the pandemic. At this moment, governments and societies around the global are fighting their best fight to contain the contagion and spreads and reduce the negative impacts on people's health, society, and economy. And we also know very well that we do have the technology capability for a much improved health surveillance system and mechanisms to spot outbreaks in much early stage and take immediate actions to contain and prevent the spread.

NYTimes reports also point to the other side of the coin - privacy. In the case of Israel, "the Shin Bet's program, authorized by the attorney general and supported by health ministry officials, was criticized by privacy advocates and some lawmakers. the Supreme Court, acting on a petition by two civil-rights groups, issued an injunction ordering a halt to the program by next Tuesday unless parliament establishes the relevant oversight committees".

Where do we draw the line and how to balance various factors at stake? Questions like this shall be addressed by legislators, judiciary systems and peoples in different countries. Somehow, this pandemic won't be a "good crisis to be wasted." For a more secure future, we will need a well-established health surveillance system, or even more broadly, surveillance for all kinds of potential disasters and crises.

NY State Governor Andrew Cuomo today made a very Presidential press briefing on combating the pandemic. He used "the Greatest Generation" to inspire his people to act and work together to win this war when his state is now the epic center of the COVID-19 pandemic. He said it so well that "Dealing with hardship makes you stronger"; "Life is not avoiding challenges"; and "Life is overcoming challenges". While he was mostly speaking to people in his state, the message rings louder and farther to the global community. "... we overcome adversity and challenges," and it is what makes us great.

Be safe! Be healthy! Be vigilant!