The cases started mounting and the death toll was increasing, but there was no certainty about the origin of the disease or its mode of transmission. And so, Dr. John Snow set about tracking cases one by one across the city, plotting the spread using maps. It was the beginning of the end of the epidemic.
The year was 1854, the city was London, and the disease was cholera. A contaminated water pump was identified as the source. Modern epidemiology was born.
More than 160 years later, faced with the challenge of the coronavirus pandemic, many of the same principles apply. Mapping is still critical, although now in digital form, as is data collection, not only collected door to door but also through applications on millions of cellular devices. In Latin America and the Caribbean, John Snow's heirs are harnessing the power of technology to respond to COVID-19.
“At the end of the day, we use new digital tools to do many of the same things that have worked in public health: we are trying to detect, prevent, respond to, and recover from disease, and the only way to do this is to obtain information that is both accurate and timely in order to make decisions,” says Jennifer Nelson, a specialist in digital health solutions at the IDB.
The use of digital tools is essential not only to provide health professionals with the best data, but also to reach patients and the public, Nelson adds. The current response, which emphasizes speedy information gathering and dissemination, is the result of challenges identified and lessons learned from SARS in 2002, MERS ten years later, and Ebola in 2014.
“One of the most powerful things we've seen with this crisis is that, with the intentional use of technology and the experience we have of what worked in past emergencies, there has been success in taking tools that were used in other crises and quickly adapting them for the COVID-19 response,” she says.
However, like any tool, digital innovations do not work on their own. Their success depends on the overarching plan of which they are a part and the clarity of purpose behind their use, warns Ferdinando Regalia, head of the IDB's Social Protection and Health Division.
“It is when digital interventions are incorporated into a coherent public-health response that they can be very powerful,” he says.
Uruguay, Costa Rica and Suriname have found success in doing so. These countries, at least for the time being, have managed to control the outbreak, thanks in part to the commitment of their health ministries to adopt new digital tools.
URUGUAY: A DATA-DRIVEN RESPONSE
“The first case of coronavirus in Uruguay was on March 13,” recalls Pablo Orefice, director of Salud.uy, a government initiative that promotes the intensive use of information and communication technologies in the healthcare sector. That same day, he says, private companies and the government began to outline the basic principles of a unified strategy for the emergency.
A single epidemiological questionnaire for the country was the first step. Disseminated through call centers, the websites of all health organizations, WhatsApp and Facebook Messenger, it sought to capture inputs from across society. Then, the Coronavirus UY application was launched to provide citizens with relevant information, daily registration of symptoms and direct contact with healthcare providers.
Information collected from these sources was channeled into a centralized database and joined to electronic medical records from all of the country’s health institutions. In Uruguay, the clinical records of 95% of the population are digitized. The information was safeguarded under a ruling on the protection of personal data for the management of COVID-19 and a telemedicine law.
An artificial intelligence algorithm then classifies each person into a traffic-light system of clinical risk, allowing health professionals to prioritize cases and contact individuals as needed. The information has also led to better planning and management of resources, informing response-capacity mapping at the national level.
“We made another application to survey the beds and supplies needed for COVID-19, from the ventilators to the human resources to care for those beds and patients. Each institution reports twice a day on the availability [of resources] and occupancy,” says Orefice.
The next step, he adds, is to use the data and digital possibilities to intelligently transition out of the lockdown and resume economic activity.
“The behavior of the curve is continually being monitored according to decisions being taken, and we are planning for the future.”
COSTA RICA: SOLID FOUNDATIONS
Like Uruguay, Costa Rica did not have to invent a digital response from scratch. When the first case of coronavirus was detected on March 6, the application for the Single Digital Health Record (EDUS, as it is known by its Spanish acronym) had been in existence for three years, supported by a system of electronic records for all public health services in the country.
“Taking advantage of the fact that we already had EDUS well positioned throughout the population – with more than a million application downloads and a deployment to around 30% of the country – we enabled two new functions in about a week,” says Manuel Rodríguez, director of the Single Digital Health Record Project at the Costa Rican Social Security Fund.
“The first was a risk test, with registration of symptoms and medical history. Two days later, we enabled updated symptom-tracking in real time. Soon, people will also be able to receive the lab result of their COVID-19 tests.”
By April 26, 127,000 users had completed a risk test. Of the total, 7,000 cases were classified as high risk, 26,000 were classified as medium risk and 47,000 were considered low risk, in addition to those who reported no symptoms.
According to the AS/COA tracker, Costa Rica has registered 815 confirmed cases of COVID-19 and eight deaths, as of May 13.
If the patient gives consent, their data is also used in a geolocation system to monitor who has taken the test by province, age and gender. The system then generates heat maps to identify where cases are concentrated and where spikes in transmission could appear.
“Looking at the system as we speak, I can see what symptoms have been most reported in the last 24 hours,” says Rodríguez. “In that time, 13 people have indicated severe respiratory distress and three report fever. We can contact all of them depending on their condition.”
SURINAME: SITE OF COOPERATION
In an emergency that knows no borders, collaboration is essential. In Suriname, the government’s response has benefited from the coordinated work of allies.
The World Health Organization provided the Go.Data tool, used previously in the Ebola epidemic, for data collection and analysis. The Pan American Health Organization (PAHO) has advised the government on its health response. The IDB has provided a loan and technical assistance to increase access to primary care services and improve the quality of the health sector.
“We work under a common objective, respecting the dynamics of each institution, but always thinking of one thing: improving public health in all the countries of the region,” says Marcelo D'Agostino, senior adviser for information systems and digital health at PAHO.
Coronavirus cases in Suriname remain very low; according to the Johns Hopkins University COVID-19 Dashboard, there were 10 confirmed cases and a single confirmed death as of May 15. But the government knows it cannot simply hope for the best.
“In order to be able to get a better grip on the pandemic, we have to use digital tools for mass communication, registration of cases and contact tracing,” said Cleopatra Jessurun, director of public health at Suriname’s Ministry of Health, and Jouke Locher, who led the implementation of Go.Data, in a joint statement.
“Because of the level of contagiousness and ease of spreading of the virus, the time we have to respond is of the essence. Digital tools are enabling us to do this, and do it in a structured way, so we have structured data to analyze and get insights into how it develops.”
PAHO’s D’Agostino says the role of digital tools in managing and mitigating the health impacts of the coronavirus sends a clear message:
“It’s time to stop seeing the issue of technologies as something simply supportive, and incorporate them into decision-making at all times. I can no longer imagine a world where, to a greater or lesser extent, technology isn’t at the heart of a health response.”
Learn more about digital interventions for public-health emergencies
Discover digital solutions from across the region