Covid-19: A much needed change in healthcare and technology?
Updated: Mar 26, 2021
The Bioengineer in me knows that soon we will have a cure to novel coronavirus, either in the form of a vaccine or a drug. But, it was during a family conversation about finding the safest way to conduct a cousin’s wedding in the post corona locked down world that I realised that even after we find a cure to novel coronavirus, our lives may change considerably. The zoonotic origins of most of the recent viral epidemics is a strong indication for us to prepare ourselves for more of these kinds of viral infections. Though their severity may vary, increased physical interaction on the global level may scale up these infections to become epidemics or pandemics. And, as the fabric of normality is ripped open by these world scale disasters, possibilities of a new format of the world starts peeping through its holes.
As we have progressed deeper into the coronavirus crisis, many of us have already started to adopt some lifestyle changes, both on personal and global scale. A poll conducted by IANS C-VOTER Gallup International Association Corona Tracker shows that there has been a 15% increase in Indians who are more vigilant about cleanliness and personal hygiene. Sales of the hand sanitizers also grew 53% in the month of February from a year ago. Simultaneously, most countries are adopting technology to fight coronavirus. While countries like Israel, China, South Korea, Germany, Italy and Taiwan have used technology to track locations of its citizens, countries like the UK, South Korea and India have developed apps to alert users when in proximity of a coronavirus infected person. To reduce human interactions, China is also using AI-powered thermal imaging systems to spot people with fever and robots to man quarantine centres. Similar robot manning quarantine facilities are also in function in Singapore.
Increasing use of technology has also become evident in the education sector where universities and schools have moved to online teaching and evaluation methods. Edtech company, Byju’s, has experienced a 60% surge in students using its products. Similarly, this virus has pushed people to work remotely evident from an upsurge in use of Zoom, Google Classroom, Moodle, Microsoft Teams and Hangouts Meet by Google.
While many of these changes may be temporary and many others may fade away gradually, the momentum in the use of technology and the lift in focus on personal health that the world has gained during this disaster will certainly continue to improve our lives long after the pandemic is over.
Here, I discuss twelve of these Covid-19 pandemic acquired changes in the society which may become an integral part of our daily lives:
1. The End of Globalization as We Know It: As the polity is turning inwards, economic and physical self-isolation has led to collaboration based on technology. Big pharma companies like GSK and Sanofi are collaborating to accelerate the research of the vaccine against coronavirus. Scientists all over the world are engaging themselves into open collaborations to aid one another. All the scientific and public health related data pertaining to coronavirus has been open to the public for anyone to do all kinds of research on it ranging from looking at the viral structure to its spread in different regions of the world. Pharma is facing a race against time to tackle the exponential rise of COVID-19 cases, and as a result there has been an unprecedented level of data sharing and cooperation even in the industry to accelerate the process.
This open sharing of data and collaborations across physical borders have speeden up the research by collating data from the entire globe. This also reduces the need of conducting conferences and large scale meetings to discuss the research conclusions. Soon, physical collaborations may cease to exist entirely due to the lack of any need for it.
2. Immunity boosting methods: The increased loss of lives by comorbidities in novel coronavirus infection has emphasised the need of putting our attention on well being and healthcare. Nutrition and proper organ functioning are key focuses in preventive healthcare. For a long time now, we have advocated on enriching our body with good nutrition with Vitamin A, B, C and E getting the highest attention. In this process, most of the time, we forget to emphasise on Vitamin D and minerals, which often leads to deficiency and later related diseases. Need of the hour is to identify the specific deficiencies in the body and enrich it with the respective vitamin or mineral.
Lack of Vitamin D, which is a very common problem in the current work schedules, can cause loss of calcium and hypertension. Proper amounts of Vitamin D in the body is essential for keeping the bone density, protection against respiratory infections like cold and flu, improving symptoms of seasonal affective disorder, reducing the risk of diabetes, preventing cognitive decline and dementia and reducing the symptoms of autoimmune disorders. Though vitamin D is not a cure-it-all nutrient, it certainly affects many important body functions which needs attention.
At the same time, a regular detoxification of liver and kidney adds to the well being. Microbiome studies have suggested that gut condition and gut microbes imbalance causes dysfunction of host machineries, thereby contributing to pathogenesis and/or progression toward a broad spectrum of diseases, including, infectious diseases, intestinal immune-mediated diseases, multisystemic autoimmune disorders, obesity colorectal cancer, and autism spectrum disorder.
A more personalised approach to preventive healthcare with immunity enhancement as its basis both at individual and society level may become a norm to prevent deaths due to comorbidities. Regular exercise on an individual scale, without the necessity of joining a crowd, may also join the cause.
3. Personal Hygiene: Infections spreading during wars and medieval ages mostly spread in the filthiest of the streets. Now, mostly our streets are clean and people use soaps and detergents on a regular basis. However, the coronavirus infection taught people to clean hands for 20 seconds which is roughly the time any surfactant would need to kill a living cell. With 15% increase in Indian attention in cleanliness, it is apparent that people have started focusing more on their personal hygiene.
Proper cleaning of surroundings and self is a very strong and stable step away from contracting infections.
4. Increased priority on healthcare: Lack of medical funds and healthcare infrastructure posed challenges in mounting an effective response against the coronavirus outbreak. Moreover, the significant inefficiency, dysfunctioning, and acute shortage of the healthcare delivery systems in the public sector appeared to be insufficient to match up with the growing needs of the population. In India most of the hospitals shut their outpatient department to reduce the load of hospitals. Furthermore, more than 80% of Indians do not have any significant health insurance coverage and approximately 68% have limited or no access to essential medicines. Also, there are only 8.5 hospital beds per 10,000 population and 8.0 physicians per 10,000.
During the coronavirus pandemic, governments have realised the unpreparedness of the healthcare policies and infrastructure for such pandemics. And, this realisation has gained interest of all governments to spend more on healthcare research and development. The urgent requirement of vaccine production for Covid-19 will also ramp up the speed of vaccine research boosting vaccine production methods in the world. This may curb down the anti-vaccine movements and allow a much faster development of the field.
5. Telemedicine: Social distancing has modified the mode of primary treatment also. Within weeks, COVID-19 has transformed our practice of palliative care and clinical medicine as we know it. Telemedicine has emerged as a critical technology to bring medical care to patients while attempting to reduce the transmission of COVID-19 among patients, families, and clinicians. It is also increasingly necessary to preserve scarce resources like personal protective equipment.
And since, social distancing will need to be in place for a long-term now, especially for senior adults, people with chronic conditions, adopting telehealth on a larger scale, as a key technology for safe and efficient communication will be a part of this new routine.
6. Food availability: In India, lockdown measures have disrupted internal supply chains halting food production and distribution. To tackle these problems we need to reduce the burden of the supply chain from human beings. Automating the supply chain systems would certainly be a way forward. In a similar effort, a combine harvester was used in Punjab, Haryana, Madhya Pradesh and Rajasthan as it can harvest acres of land at one go and doesn’t require much labour. Most of the other Indian states have also automated their harvesting systems.
Covid-19 has also exacerbated the food shortage in East Africa. The upcoming industry of cellular agriculture, which allows the production of meat and food products for humans and animals in a bioreactor in a laboratory, is a good solution to this problem. Food in factories would be more automation friendly as well as easier to prevent contamination. Culturing meat in large bioreactors in every part of the world will also reduce the burden on increasing the agriculture produce and the need for its timely transportation.
While, most agriculture societies will welcome and embrace this automation to sustain uninterupted supply chain and harvesting, the industries will innovate and identify lab based methods to compensate for the food shortage.
7. Faster methods of drug designing and testing: Traditionally, it takes 3–5 years to discover and optimise molecules with animal studies before they are tested in humans. Rational and direct repurposing efforts can take anywhere between 1–3 years. To reduce the time taken in the drug discovery process, the use of artificial intelligence (AI) in drug development has increased immensely during the COVID-19 pandemic. This would save multiple years and billions of dollars to bring a new treatment to market. Many AI-drug discovery companies are working to speed-up a rational repurposing of the available drugs against the novel coronavirus. BenevolentAI, Innoplexus, Deargen, Gero, Cyclica and Healx are few such companies which are using their AI platforms to narrow down the best repurposed drug candidates against coronavirus infection or to uncover bi-and tri-combinations of approved drugs against the virus. Hydroxychloroquine (approved to treat Malaria) and Remdesivir (for Ebola) are the two best-known examples of this so far. At the same time, AI platforms are also being used vastly to design new drugs. European companies like Insilico medicine, Exscientia and Iktos are using their AI modules to identify the right chemical compositions or to design novel molecules in the fight against covid-19.
Many in the industry believe that the use of AI is overhyped in drug discovery. If these AI discovered molecules prove to be successful, it will set the wheel to churn out accelerated therapies at a price that every patient around the world would welcome.
Bigger problems arise during the testing of these drugs. In 2006, six healthy men who participated in a seemingly harmless clinical trial for a new drug were instead left fighting for their lives with multiple organ failure. The disastrous trial emphasized the lack of physiologically relevant preclinical models that can predict human responses to new drugs. Recent research has led to the development of what are called “organs-on-a-chip” (OOCs) to test the effects of drugs as an alternative to animal experiments, which may produce results inconsistent with human trials. Since 2010, OOC models have been developed for the brain, lung, skeletal muscle, heart, skin, kidney, liver, gut and bone. Recently, an integrated three-tissue OOC system comprising liver, heart and lung has also been developed. The resulting drug responses depended on interactions among the three tissue types, which reinforces the need to combine multiple tissue or organ types within a single microfluidic device. Although the OOC remains an in vitro platform, it aims to replicate the in vivo environment of an organ with fabricated microwells, fluidic channels and porous membranes. Then, there are the practical advantages of OOCs such as saving on cost, time and labour. Another fast and cheap method to the traditional forms of drug testing is 3D printed organs. Similar to OOCs they can be produced on a large scale in labs and replicate the in vivo environment.
The need to produce effective drugs at a much faster rate has pushed the advances in drug development towards more technology based methods which require less human intervention and involvement. With social distancing in place for an extended period of time and because of their time and cost effective nature, these technologies may take a front seat in drug development protocols.
8. Increased reliance on artificial intelligence (AI): Covid-19 pandemic has accelerated the use of AI exponentially. From drug development to identification, tracking, and forecasting of outbreaks to diagnosis of infection to processing of healthcare claims, AI is being used everywhere. In China, drones are being used to deliver medical supplies. China and India are also using drones for surveillance. In hospitals, robots are being used for sterilisation and delivering supplies and food. Several countries are already using apps based on AI to identify infected or non-compliant individuals.
Such widespread use of AI has become an integral part of the system and it will certainly continue to increase hereafter.
9. Reshoring of pharma production: Coronavirus pandemic has made most developed countries increasingly aware of the dearth of production of pharmaceutical essentials within their own boundaries. At present, the US is dependent on China for over one third of all the imported antibiotics. The US also imported 3.5 million tablets of hydroxychloroquine, an anti-malaria tablet which is considered to be a potential candidate to cure coronavirus infection. In 2019, imports of pharmaceutical products in the US totaled $127.6 billion.
During a time of crisis like a pandemic, bans on export of medical equipment and essential medicines creates a sense of panic. Covid-19 pandemic created such panics on several accounts. To avoid such situations in future, developed countries like the US, who have always believed in off-shoring their resources may begin to reshore the production of such essential commodities. Reshoring of pharmaceutical production will also stimulate the US economy, leading to more imports, partially offsetting the direct reduction in imports from the pharmaceutical reshoring. They are also strategic; in that they would reduce US dependence on potentially hostile countries like China. In times of pandemic, there is also a non-zero risk that even friendly nations will prioritize their own citizens over exports.
The benefits of reshoring pharmaceutical and ingredient production are large in terms of national security, patient safety, and economic welfare. Research shows that a realistic reshoring program could create 804,000 US jobs and add $200 billion to annual GDP in the first year. The benefits in terms of security of supply are separate, and in times like the present, critically important.
10. Increase in surveillance systems: Globally, governments have turned to physical- and bio-surveillance to contain the pandemic. The Russian government is reportedly using facial surveillance technology to identify people who may have violated quarantine orders. Various European countries have embraced the use of tech tools including AI-powered lie-detector tests and drones for migration management. In the US, Google and Apple have collaborated to create their own surveillance solution. Together, these tech giants aim to collect information from their 3 billion users to contact trace, enabling the government to know if users have come in contact with someone who has tested positive for Covid-19.
Israel, South Korea, China and Taiwan have also used location-tracking widely to limit the transmission of the virus. India, Singapore and South Korea are using apps based on bluetooth to check if anyone has crossed paths with any coronavirus infected person. South Korea, Singapore and an Indian strate, Kerala, have used CCTVs extensively in contact-tracing.
The immense amount of data received by the governments from these apps and location tracing will allow them to track their citizens and influence them based on their activities. Though tech companies like Google and Facebook have been doing it for a number of years now, the use of such data by the government will give them a heightened control over their citizens.
11. More allowance of remote working: Coronavirus has exposed more people to working remotely than ever. Most people have seen that it is very possible to work remotely and have been familiarised with the benefits of remote work, including autonomy, no commute, and less distractions than open offices. Research shows that teleworkers in British Telecom are up to 40% more productive when they can work from home. Remote working also slashes down the real estate costs for the company by a considerable amount and gives a liberty to recruit professionals from all over the world irrespective of physical and time zone barriers.
After COVID-19 passes and businesses try to return to normal, there is a real possibility that professionals may change their preferences in the choice of job type. Research from the International Workplace Group showed that 80% of job seekers would choose a job with a flexible work-from-home policy. Thus, companies that allow remote work already may continue to support it going forward, now that they have proven to themselves that it works.
12. Increased dependency on e-learning: Covid-19 has also affected more than 1.2 billion children in 186 countries due to school closures. In India, most engineering, technical and management institutes, as well as many private educational institutions, have been quick to transition to online teaching and learning. Teaching and learning online has been quite successful in higher educational contexts. Massive Open Online Courses (MOOCS), a blended-model of online (asynchronous) teaching and Learning Management Systems (such as Blackboard or Moodle) has become a norm for every educational institute.
With global edtech investments reaching US$18.66 billion in 2019 and the overall market for online education projected to reach $350 Billion by 2025, it is a very lucrative business. Whether it is language apps, virtual tutoring, video conferencing tools, or online learning software, there has been a significant surge in usage since COVID-19.
The ease and cost-effectiveness of e-learning has made it an integral part of the education system and most education institutions are preferring to become more and more tech friendly by educating their faculty to make e-learning a part of their norm.
Major world events are often an inflection point for rapid changes and innovation. Many of these changes persist in society — a clear example is the rise of e-commerce post-SARS. While we are yet to see which of the developments of COVID-19 pandemic will prevail after the pandemic subsides, it has become clear that this pandemic has diminished the importance of physical borders and enhanced technological usage in all parts of society.