Long-Term Utilization of
Pandemic-Emergent Technologies

COVID-19 accelerates the move to a more comprehensive and connected approach to care Radha Shenoy and Sudha Shenoy

Photo: iStock.com/Arkadiusz Warguła

The COVID-19 health crisis has reshaped every aspect of our existence, forcing us to reconsider how we conduct business and carry on with our personal lives. The pandemic has greatly accelerated the use of existing technologies as well as introduced both new and promising pipeline technologies. Many business and personal activities have switched from in-person interactions to digital and online modes. Some solutions to social distancing guidelines include working from home, teleconferencing, attending telehealth appointments and educating students via virtual classrooms. In addition, advances in biomedical technology have enabled us to mass produce personal protective equipment (PPE), ventilators and other medical devices as well as develop new medications and encouraging pipeline therapies to combat the virus.

This article seeks to examine the use of technology during the COVID-19 pandemic and how it may impact post-pandemic technology utilization in health care and health-related areas such as testing, diagnosis and contact tracing; drug, vaccine and medical device development; hospital and other business operations; patient, family and provider communications; artificial intelligence (AI); and medical education.

Testing, Diagnosis and Tracing

The urgent need for testing, diagnostic and tracing measures has placed an undue burden on the private sector, with several companies rising to meet the demand. In doing so, they have increased the use of existing technologies and accelerated the development and use of new ones. Online chatbots (e.g., Novo Nordisk’s Sophia chatbot)1 and symptom checkers have assisted patients in determining what level of care they should seek.2 Relatively new methods such as 3D printing have been employed to create nasopharyngeal testing swabs,3 and robots are being developed to conduct these tests.4

Available SARS-CoV-2 tests include antibody tests (e.g., Siemens Healthineers’ Advia Centaur COV2G and Atellica COV2G tests);5 antigen tests (e.g., BinaxNOW COVID-19 Ag Card: Abbott);6 saliva-based tests (e.g., SalivaDirect: Yale School of Public Health)7 and tests that use cutting-edge techniques such as clustered regularly interspaced short palindromic repeats (CRISPR) to provide accurate diagnoses at the point of care (i.e., the Sherlock CRISPR SARS-CoV-2 kit).8 Other approaches, such as pooled sample tests and combined Sars-CoV-2/influenza assays (e.g., Winterplex respiratory test panel: Novacyt S.A.),9 seek to conserve precious resources and increase diagnostic efficiency.

Once individuals have received a diagnosis of SARS-CoV-2, GPS and phone data may be used to trace and notify their contacts.10 Some states, such as North Dakota, Virginia, Alabama and Wyoming, have rolled out their own contact tracing applications.11

Treatment and Prevention: Drugs, Medical Devices and Vaccines

Rapid therapeutic advances have thrust several nascent technologies into the limelight. Some device companies have created remote-controlled ventilators,12 while others are developing sensor-embedded clothing and other technologies equipped with remote patient monitoring (RPM) capabilities. 3D printing has been used to produce masks and respirators for medical personnel.13 The Food and Drug Administration (FDA) has granted companies permission to supply their still-investigational devices, such as the Hemolung Respiratory Assist System (ALung Technologies, Inc.)14 and CytoSorb blood purification technology (CytoSorbents),15 to COVID-19 patients in need. Other device companies have repurposed existing devices in innovative ways, such as turning snorkel masks into respirators,16 converting CPAP machines into respirators or ventilators,17 and finding ways to modify single-person ventilators to service multiple patients.18

Pharmaceutical and biotechnology companies also have stepped up to the plate with innovative contributions in the gene and cell therapy space. Therapies in development for COVID-19 include convalescent plasma-based therapies; CYNK-001, a placenta-derived treatment; Viralym-M, a T-cell treatment; PAC-MAN, a gene editing therapy utilizing CRISPR technology;19,20 Ryoncil (remestemcel-L), a stem-cell treatment for children who have developed COVID-19-related multisystem inflammatory syndrome;21 and AeroNabs, a therapy based on llama nanobodies.22 Longstanding FDA-approved medications such as dexamethasone and the interleukin inhibitors are also under investigation to treat COVID-19.23,24

Some SARS-CoV-2 vaccines in development are based on the introduction of protective genes into the body via the use of viral vectors (e.g., adeno-associated virus (AAV) vectors), while others utilize a technique similar to gene therapy to deliver fragments of SARS-CoV-2 into the body to provoke an immune response.25,26 New routes of administration are also under investigation, such as inhalation (e.g., inhaled formulation of remdesivir) and liposomal inhalation therapies to introduce medications and vaccines directly into patients’ damaged lungs.27,28

Hospital Operations

Hospitals have found inventive ways to function in the pandemic era, as well. Arizona has been working with third-party vendor Central Logic to create an inter-hospital system that monitors patient counts, vacant beds, available supplies and unoccupied medical personnel to optimize care and resource allocation while minimizing the care burden on any given hospital. Other organizations, such as the Carilion Clinic’s Transfer and Communications Center in Virginia, have developed strategies that maximize the use of smaller hospitals to free up space in tertiary hospitals for more complex cases.29

AI Applications

Basic applications of AI include using appointment reminder platforms to text, call or email patients to distribute COVID-19-related information/dispel misinformation, refer patients to online resources and/or disclose test results.30 Some reliable sources of information include government sites such as the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) websites, though the latter has bowed to political pressure in some of its recommendations recently.

More sophisticated examples include Massachusetts General Hospital radiologists’ use of AI to analyze chest X-rays of COVID-19 patients. The results of these analyses help in determining optimal treatments for patients when assessed alongside laboratory findings, vital signs data and oxygen saturation readings (low oxygen saturation levels are an indicator of COVID-19-induced lung damage).31

Examples of smartphone-compatible AI include PulseNmore’s mobile tele-ultrasound platform for pregnant women32 and AliveCor Inc.’s Kardia products (e.g., Kardia Pro, KardiaMobile, KardiaCare), the first of which received FDA approval in 2017.33 The Kardia devices use AI to monitor patients’ weight, blood pressure and heart activity (via electrocardiogram (EKG)). These devices have been designed to alert patients and their providers to early signs of atrial fibrillation.34,35

Apple Watch, a personal wearable device, includes AliveCor’s KardiaBand EKG offering.36 Not to be outdone, Samsung offers remote EKG and oxygen saturation monitoring (among numerous other features) in its Samsung Galaxy Watch3 Smartwatch. The Galaxy Watch3 Smartwatch may offer cuffless blood pressure monitoring in the future.37 Eko has been utilizing its Emergency Use-Authorized AI technology to identify COVID-19-associated heart abnormalities,38 while Fitbit is in the process of analyzing changes in heart rate, breathing, sleep and physical activity to identify presymptomatic cases of COVID-19.39

AI has played a crucial role in enabling hospitals to expand their offerings, as well. One truly transformative application of AI is the creation of “virtual EDs” by third-party vendors Vituity and Decoded Health. These virtual emergency departments use sophisticated chatbots called “virtual medical residents” to evaluate symptoms and vital signs and route callers to the appropriate personnel. Staff members must review the chatbots’ reasoning to ensure that the patient has been referred to the correct area. Physicians then address callers’ concerns via video conference. Patients who are advised to recover at home have their vital signs monitored remotely and may speak to nurses and other providers via a video interface at any time. Patients who must be evaluated in-person are entered into the hospital’s electronic health record (EHR) system. Tests and medications may be ordered through this system before the patient even arrives at the hospital. The Vituity virtual ED platform reduces emergency room (ER) volume and decreases ER staff utilization, thereby freeing medical personnel to treat patients in other departments (e.g., the intensive care unit (ICU)).40,41

Patient, Family and Provider/Caregiver Communications

Communications between patients, patients’ families and providers rely heavily on the use of existing technologies such as phones, tablets and audio/video applications (e.g., Zoom, Google Meet FaceTime). These communications include phone and video conferencing for telehealth appointments and iPad and cellphone use to facilitate hospitalized patients’ interactions with medical personnel as well as with family members who are barred from visiting due to the extremely contagious nature of the SARS-CoV-2 virus.42,43

Regulatory Flexibility

Some of these changes in practice, such as telehealth, would not have been possible without regulatory flexibility on the part of the Centers for Medicare & Medicaid Services (CMS). The agency now reimburses telehealth visits at the same rate as face-to-face visits and has allowed physicians from 135 additional specialties, including physical therapy and hospice care, to offer telehealth services to their patients. Phone-only telehealth visits are now eligible for reimbursement, whereas only video and audio sessions qualified for payments in the past. Medicare beneficiaries may now partake in telehealth services anywhere, including in urban areas and/or at home; previously, only individuals who resided in rural areas were eligible for telehealth coverage, and even then, many patients were required to travel to medical facilities to participate.44 In addition, CMS has been experimenting with pilot programs that reimburse physicians for follow-up telehealth visits with individuals discharged from the ER, including COVID-19 patients or individuals at high risk for contracting the disease.

Regulatory flexibility has also occurred at the state level. For example, Colorado, Nevada, Oregon and Washington are creating an interstate telehealth network to better serve the region.45 Another example is when New York’s Governor Cuomo suspended the in-state licensing requirement for nurses, which allowed nurses from other states to travel to the New York City area and provide their much-needed services.46

Business Operations

Businesses have demonstrated flexibility in their operations, as well. Many businesses have transitioned large numbers of employees to working at home and have moved industry conferences and trade shows to the virtual realm. CVS Health and Salesforce’s Work.com have created a return-to-work platform that combines employee wellness monitoring, contact tracing and COVID-19 expertise.47

Pharmaceutical representatives’ interactions with physicians also have transitioned online,48 as have many clinical trials.49 Eli Lilly has found an especially innovative way to conduct clinical trials: in nursing homes, with the use of mobile laboratories stationed outside.50 Rival pharmaceutical companies have been collaborating to rapidly develop, mass produce and distribute medications and vaccines against the virus. For example, Pfizer and Hikma have been assisting Gilead Sciences in mass producing its promising antiviral agent remdesivir,51and Eli Lilly, AstraZeneca, Genentech, Amgen and AbCellera have been exchanging information on manufacturing, supplies and production capacity to ensure that their respective monoclonal antibodies will be ready for distribution immediately following FDA approval.52 Collaborations between pharmaceutical companies and universities and government laboratories and universities also have increased.53,54 The FDA has brought many of its regulatory activities, including Advisory Committee meetings, online.

Perhaps most striking is the contribution that businesses outside of the health care space have made to the collective effort. Examples include Coca-Cola stepping forward to produce plastic vials for testing,55 Honeywell developing Aclar thermoplastic film containers for vaccine storage56 and automobile companies such as GM and Ford switching gears to mass produce ventilators for patients with severe COVID-19.57 Investment activity has risen, with investors pouring money into drug developers such as Gilead (remdesivir’s developer), vaccine developers such as NovaVax and Pfizer, and telehealth platforms such as Teladoc, which is in the process of acquiring Livongo, a telehealth company that offers RPM and chronic disease management for conditions such as diabetes and mental health.58,59

Medical Education

As medical schools closed across the country, many universities began offering classes online by way of virtual classrooms. Online medical education (as well as nonmedical education and even primary and secondary school education) has provided a partial solution to pandemic-related disruptions. Some nursing programs now offer virtual shadowing programs while many medical school classes include virtual reality (VR) training modules, such as Osso VR’s surgical training program designed to run on MicroPort Orthopedics’ SuperPATH Hip Technique and Evolution Medial-Pivot Knee System.60

The use of VR has helped offset students’ loss of hands-on training. Many conferences that offer continuing medical education (CME) for medical professionals have gone virtual, as well. For example, this year’s American Society of Clinical Oncology (ASCO) conference was conducted completely online.

The Future

The COVID-19 pandemic has served as a potent catalyst in increasing the use of existing tools and expediting the development of new technologies. Stakeholders, including (but not limited to) patients, physicians and hospitals, will continue to benefit from these advances. Telehealth and RPM are expected to play an increasing role in care for the duration of the pandemic and beyond.61,62,63

President Trump issued an executive order to protect regulatory changes in telehealth, including CMS reimbursement modifications.64 RPM will become a routine care option for patients, especially for seniors who may experience difficulty leaving the house due to health issues such as depression, cognitive decline, dementia and mobility impairments.65,66 Home health visits are expected to increase, as well.67

RPM offers convenience and may ease ER congestion.68 The use of online interfaces, phone applications, wearable devices, auto-injectors, remote-controlled machinery, AI and other technologies and processes that facilitate RPM are expected to rise.69,70 Physicians and older patients, two groups that historically have demonstrated resistance to new technologies, have expressed a willingness to continue using telehealth and RPM platforms.71,72

AI will play an increasingly important role in shaping medical practice as well as hospital and business operations. Predictive AI is expected to give rise to platforms that will identify ill individuals, evaluate their risk for complications such as renal disease, and project their path to recovery.73,74,75

Business operations are expected to largely remain in the “telerealm,” as telework and online conferences not only offer convenience and safety but also cut down on overhead and other expenses. Interactions between pharmaceutical representatives and physicians are likely to remain online,76 as will the conduction of clinical trials, when possible.77 Experts also believe that collaboration among different pharmaceutical companies and cooperation among pharmaceutical companies and other research institutions will continue.

Perhaps the greatest transformation the COVID-19 pandemic has generated, however, is a change in patterns of thinking. Faced with a novel disease, different segments of society have rapidly developed innovative ways to fulfill unmet patient needs and overcome gaps in the health care system. Collective efforts toward a common goal have produced tremendous results in a brief period of time. We now know that this level of productivity is possible, which begs the question: Why has it taken a pandemic for health care to realize its full potential? The creativity and collaboration we have witnessed in the past several months can, and should, continue their upward trajectory into the future. We all stand to benefit from this more comprehensive and connected approach to health care.

Radha Shenoy, MPH, holds degrees from Yale University in English and Public Health and has worked on Optum’s Health Technology Pipeline product for the past decade.
Sudha Shenoy, FSA, MAAA, CERA, is president of Steer Health.

Copyright © 2020 by the Society of Actuaries, Chicago, Illinois.