This pandemic has been a wake-up call for all of us in the industry to build a better stress test to our healthcare system.

The global economy is expected to suffer $6 to $8 trillion in losses due to the coronavirus pandemic in 2020. The pharmaceutical, medical devices, diagnostics, imaging and digital health markets will lose $90 billion in potential products revenues. The market will grow by 0.6% in 2020. In the absence of the pandemic it could have crossed $2 trillion but now we stand to lose $92 billion of that potential revenue.

Main reasons for this decline include:

Delay in new product launches

The new key drugs that were supposed to be launched in 2020 were expected to generate $3 billion in revenues. However, launch of several drugs have been halted. Further, the largest and greatest tradeshows in medical imaging, where we usually see product launches, never took place.

Slump in elective surgeries and hospital administered drugs

Frost & Sullivan’s recent study revealed that for June, US surgeries in different specialties declined heavily. E.g.: Plastic Surgery: -100%, ENT: -79%, Ophthalmology: -66%, Cardiovascular: -53%, Neurosurgery: -47%, General & Abdominal: -43%, Orthopedics: -37%, OB/GYN: -49%, Urology: -33%.

Inadequate infrastructure for virtual care

In many countries, we’ve seen 70% to 80% of primary-care consultations either go online or be carried out by phone. Do we have the infrastructure to carry this out seamlessly-the answer is “No”. Well established Telehealth protocols are lacking and many aspects within a virtual visit need improvement.

These include the patient's ability to use devices to perform certain tasks for the physician, such as accurate BP, heart rhythm evaluation, or even gathering samples for a lab test. Broadband access, training to manage a video visit, security breaches and concerns about privacy continue to cause concern among patients and providers.

The top 5 predictions for H2 2020

Virtual consultations will witness greater than 100% growth in the United States

Virtual visits is expected to witness 124.3% revenue growth in 2020 in the United States alone, which is the largest telehealth market as well as a COVID-19 hotspot. Greater adoption will also be witnessed in Germany and the United Kingdom.

There is a strong impetus from governments to standardize the use of telehealth tools. Medical device and diagnostic companies should look at partnering with or acquiring telehealth providers to expand their diagnostic capabilities.

There will be an emergence of new point-of-care testing sites to treat the $5 billion infectious disease market globally this year

In the United States, numbers suggest that more than 1% of the population have been tested; effective surveillance requires doubling the testing capacity at a minimum. We believe that the testing market is going to be reinvented with a couple of movers and shakers that are changing it. Demonstrated benefits of IVD services in a retail setting will challenge traditional diagnostic labs. With the wide adoption of POCT technologies and higher expectations from customers, retailers (particularly pharmacies), may find providing selected diagnostic tests a complementary service offering. This effort will be amplified by integration with patient electronic health records (EHRs), including patient data from the pharmacy.

Critical care ventilator market to reach $2.4 billion in the United States and ~$1.5 Billion for Western Europe

The United States will have excess of 100,000 ventilators, while Western Europe will purchase another 30,000 to 50,000 ventilators through the end of 2020. The current procurement includes a mix of conventional high-end and portable ventilators. Adoption of wearable, analytics, and cloud technology will continue providing effective remote monitoring solutions. However, cybersecurity and interoperability challenges will have to be addressed.

33% of global clinical trials will be disrupted, putting $3 Billion in new product revenue at risk

The clinical trials IT solutions market (enabling patient recruitment and remote monitoring required for virtual trials) is expected to reach $560 million, driven by mHealth solutions. Potential cost savings in virtual or remote patient monitoring trials will be the highest in central nervous system-focused areas such as pain and anesthesia with the potential of saving $10 million per study, followed by hematology trials with expected savings of up to 20%.

Informatics and AI solutions addressing workflow automation, and operational analytics will witness 100% growth In 2020

As patients accept the new normal and begin to feel comfortable returning to hospitals, the number of elective procedures will surge due to pent-up demand. Radiology departments that have been operating at 25%-30% of capacity during the pandemic will scale up to 65%-75% capacity by Q4 2020. Equipment that embeds workflow automation, image sharing, and analytical solutions will boost workflow by 40%-50%, allowing for higher procedure volumes. The pandemic has proven the value of teleradiology and AI technology and most importantly the cost savings from that.

Last word

We have gained tremendous amount of learning during this pandemic. The big question for all of us is - how do we leverage this learning and apply it during a non-crises time? A large part of how we adapt at peacetime will determine our success.

Doctors at Cleveland Clinic Abu Dhabi have performed the first robotic “whipple” procedures to treat pancreatic and duodenal tumors in the UAE, expanding the application of specialised assistive technology to treat complex diseases and conditions.

Robotic surgery is an advanced form of minimally invasive or laparoscopic surgery. It has transformed the care and treatment of prostate cancer, digestive diseases, urological procedures, hysterectomy and mitral valve repair – all of which are performed by experts at Cleveland Clinic Abu Dhabi – by increasing the precision of operations and reducing patients’ recovery time.

During robotic procedures, the surgeon controls instruments attached to mechanical arms, gaining a high-definition, three-dimensional view of the surgical site. The hospital carried out its first robotic operation in 2015 and the first robotic whipple procedures in 2018.

“Robotic-assisted surgery is becoming the standard of surgical care in many specialties around the world. Patients in the region are increasingly seeing the advantage of opting for such minimally-invasive procedures over traditional open surgery,” said Dr. Yasir Akmal, a Staff Physician of General and Oncologic Surgery in the Digestive Disease Institute at Cleveland Clinic Abu Dhabi.

“This technology was developed to help surgeons overcome certain limitations and enhance their capabilities during complex surgical procedures. At the same time, patients benefit from smaller incisions and scarring during the procedure, and faster recovery time,” he added. 

Dr. Akmal says not all patients are candidates for robotic surgery, and a multidisciplinary team at the hospital collaborates to review each case to determine the right course of action.

Robotics enables dexterity

Explaining his most recent fully robotic whipple procedure to treat a tumor, the expert says such assistive technology enhances precision during such high-risk procedures and leads to better outcomes for the patient.

“A whipple procedure is a complicated operation to remove or resect the head of the pancreas and portions of the small intestine and bile duct. After the procedure, we must reconnect the remaining organs for the normal functioning of the digestive system,” he says.

“Using robotics enables us to have more dexterity and control, increases our visibility, reduces the surgeon’s muscle tremor and enables us to move our instruments in a way that a human wrist cannot.”

“Additionally, instead of make one large incision in the patient’s abdomen, which increases the stress on the body and leads to more fluid loss, robotic surgery allows us to make five to six small surgical cuts instead, causing fewer wounds, and reduced pain and recovery time.”

Dr. Akmal says any concerns around the use of robotics are addressed during a comprehensive discussion with patients and their families on the different treatment options.

“Cleveland Clinic Abu Dhabi is among only a few facilities in the country that have a multidisciplinary team with a high level of expertise and proficiency in medical robotics. One of the biggest concerns for our patients is around the surgeon’s involvement in the surgery and we reassure them that the robot is just an advanced tool to assist us. The team always has a surgeon on the console controlling the robot and one at the bedside guiding and tailoring the procedure to the patient.”

M.S.V, a 55-year-old patient who opted for a robotic whipple surgery at Cleveland Clinic Abu Dhabi, admits that she had some initial reservations about the procedure.

“I had so many questions but Dr. Yasir said I was a good candidate for robotic surgery after doing a thorough investigation. He was very transparent and explained all the benefits and possible complications, which helped instill the confidence I needed to go ahead. I think it is very important to build that rapport and trust with your doctors.”

The Abu Dhabi resident says that the operation went well, and she continues visiting her doctor for routine check-ups.

“My minor post-op complications were dealt with immediately and I had a good recovery, thanks to the kind and attentive team at the hospital. I love going back for my follow up scans and tests because I am so attached to my care providers.”

The following article originally appeared in full, including figures and data, on Cleveland Clinic Journal of Medicine July 2020 as part of its COVID-19 Curbside Consults series.

Physician burnout is not new, but the COVID-19 pandemic is accelerating the many negative repercussions of uncertainty and inadequate support, and the consequences are being felt by patients, physicians, and healthcare systems.

Physician burnout has serious consequences to the individual physician, to patients, and to healthcare institutions. Research has shown the prevalence of burnout to be more than 40%, with highest rates in frontline healthcare providers such as emergency medicine, primary care, and critical care. COVID-19 presents new stressors for healthcare providers, and recent events involving self-harm by physicians have brought increased attention to the emotional impacts of caring for these critically ill patients.

New stressors in COVID-19

Related: How to protect the wellbeing of healthcare staff in the COVID-19 crisis

COVID-19 presents multiple stressors to healthcare providers, including risk of infection, social isolation, and economic consequences. The practice of medicine has changed with COVID-19, with decreasing outpatient revenue, reductions in salary and benefits, and increased use of telemedicine, with its effect on the doctor-patient relationship.

A survey by the Society of Critical Care Medicine of nearly 9,500 critical care providers showed that median self-reported provider stress has increased from a score of 3 to a score of 8. Top stressors included lack of personal protective equipment, fear of contracting COVID-19, and fear of spreading the infection to family members. These work-related stressors have been associated with anxiety and depression, and they reflect real physical and emotional risks faced by frontline providers. In addition to these concerns, another recent survey also noted worries about being asked to care for patients more critically ill than they are trained for and about the limited availability of up-to-date information.

Related: 5-step guide to ensuring employee mental and physical wellness

Research out of China about mental health outcomes of healthcare workers treating COVID-19, although limited, indicates that nurses, women, and frontline healthcare workers experience the highest psychological burden and develop the most unfavorable mental health outcomes, including depression, anxiety, and insomnia.

Social and family support are vital pillars in promoting resilience and preventing burnout; however, COVID-19 poses challenges to both. Healthcare providers are hesitant to spend time with family members due to the risk of spreading infection to their loved ones, and many healthcare providers isolate themselves within their homes. Similarly, social distancing makes it more challenging to keep in touch with friends.

Many providers are experiencing increased demands at home, as the closing of schools and daycare centers has made finding childcare a major challenge, particularly when the healthcare provider is a single parents or when both parents are essential employees. In addition, childcare workers are hesitant to work in homes of healthcare workers due to fear of getting COVID-19.

COVID-19 is presenting economic challenges, with decreased revenue in hospitals and outpatient practices. Decreasing revenues are leading to reductions in salary, benefits, and vacation time to make up for lost revenue.

Signs of burnout

Burnout does not have a universal definition and is specifically job-related, as opposed to depression. Common signs of burnout are feelings of emotional exhaustion, cynicism, depersonalization, and low personal accomplishment. Maslach Burnout Inventory, the gold standard for measuring occupational burnout, is a 22-item questionnaire measuring three domains of burnout: emotional exhaustion, depersonalization, and low personal achievement. A high score on emotional exhaustion and depersonalization and a low score on personal accomplishment indicates burnout. And the response to even single statements such as “I feel burned out from my work” and “I’ve become more callous toward people since I started this job” have shown good correlation with emotional exhaustion and depersonalization.

Consequences of burnout

Physician burnout has negative consequences to the physician, patients, and the organization. It is associated with increased rates of medical error and decreased productivity, putting patients at risk and straining an already overstretched medical system. Perhaps most pressing now are the well-studied links between physician burnout and depression, alcohol abuse, and suicidal ideation. It is well documented that physicians take their own lives at rates much higher than the general public, and on average, 400 US physicians die by suicide each year. Drastically increasing stressors on healthcare providers both during work and outside of work without adequate approaches for how to combat these stressors will increase the rate of physician burnout.

How to prevent burnout during a pandemic

Preventing burnout relies on interventions at individual, team, and institutional levels. Research has shown benefits of mindfulness, stress-management training, exercise programs, and participation in small-group programs focusing on community, connectedness, and meaning in helping providers deal with burnout. Identifying signs of burnout in friends and colleagues and reaching out can be an important first step in getting them support.

Stressors, symptoms, and strategies to cope

Organizational strategies such as limiting physician hours, particularly in intensive care units, promoting a sense of community and core values, and engaging physicians in establishment of new protocols has been shown to prevent burnout. Ensuring availability of personal protective equipment and being open with staff about current resources can ease some of the anxiety that comes from uncertainty. Providing accurate and timely information about providing care to COVID-19 patients can promote standardization and encourage efficiency throughout the healthcare system.

There have also been team-based strategies adapted from those used in the military, where groups are routinely asked to work in high-stress environments. Having end-of-shift debriefing sessions normalizes talking about anxiety and grief and gives people tools to voice their experiences. Having “battle buddies,” people paired with a partner to support and check in on one another, can provide support in a way that friends and loved ones who are not in healthcare may not be able to do.

Conclusion

The mental health impacts of COVID-19 on frontline healthcare workers are undeniable. While physician burnout is not new, the pandemic is rapidly accelerating the many negative repercussions of uncertainty and inadequate support, and the consequences are being felt by patients, physicians, and healthcare systems. However, this time of change is an opportunity for a cultural shift in how we perceive and manage physician mental health. Perhaps the tragic events involving self-harm in New York City can serve as a wake-up call to the emotional tolls of caring for COVID-19 patients and our responsibility to support ourselves and our colleagues.

The proportion of children under five years of age chronically infected with hepatitis B (HBV) dropped to just under 1% in 2019 down from around 5% in the pre-vaccine era (the period between the 1980s and the early 2000s), according to new estimates from the World Health Organization (WHO).

This marks the achievement of one of the milestone targets to eliminate viral hepatitis in the Sustainable Development Goals ─ to reach under 1% prevalence of HBV infections in children under five years of age by 2020.

“No infant should grow up only to die of hepatitis B because they were not vaccinated ─ today’s milestone means that we have dramatically reduced the number of cases of liver damage and liver cancer in future generations," said Dr Tedros Adhanom Ghebreyesus. "Preventing mother-to-child transmission of hepatitis B is the most important strategy for controlling the disease and saving lives. Even in the midst of the COVID-19 pandemic, we must ensure that mothers and newborns have access to life-saving services including hepatitis B vaccinations.”

On World Hepatitis Day 2020, WHO is calling for united and stepped-up action to build on this achievement through intensified efforts to prevent mother-to-child transmission of HBV through testing pregnant women and provision of antiviral prophylaxis to those who need it and maintaining and expanding access to hepatitis B immunization and birth dose vaccine.

Globally, more than 250 million people are living with chronic HBV infection. Infants are especially vulnerable: about 90% of children infected with HBV in their first year of life become chronic HBV carriers. HBV attacks the liver and claims the lives of nearly 900 000 people each year.

Preventing hepatitis B

Infants can be protected from HBV through a safe and effective vaccine that provides over 95% protection against infection. WHO recommends that all infants receive a first dose of the hepatitis B vaccine as soon as possible after birth – preferably within 24 hours – followed by at least 2 additional doses.

The scale-up of hepatitis B vaccine worldwide over the last two decades, which has been in large part due to the support provided by Gavi, the Vaccine Alliance, has been a great public health success story and contributed to the decrease in HBV infections among children. In 2019, coverage of 3 doses of the hepatitis B vaccine during childhood reached 85% worldwide, up from around 30% in 2000. However, access to the first critical dose within 24 hours of birth remains uneven. Global coverage of this birth dose is 43%, but this drops to 34% in the WHO Eastern Mediterranean Region and only 6% in the WHO African Region.

“Expanding access to a timely birth dose of the hepatitis B vaccine is the cornerstone of efforts to prevent mother-to-children transmission of HBV. For countries especially in regions such as sub-Saharan Africa, where the birth dose of hepatitis B vaccine has not yet been introduced, it is a priority to assure that protection as early as possible,” said Dr Meg Doherty, Director of Global HIV, Hepatitis and STI Programmes.

An additional way to protect children is to provide pregnant women with antiviral treatment to reduce mother-to-child transmission of HBV. WHO already recommends routine testing of all pregnant women for HBV, as well as HIV and syphilis as early as possible in their pregnancy. In view of new evidence on the safety and efficacy of antiviral prophylaxis in pregnant women and their children, WHO is issuing today 2 new recommendations:

• Pregnant women who test positive for hepatitis B infection and have a high level of HBV in the blood (known as HBV viral load) should receive preventive antiviral therapy with tenofovir from the 28^th week of pregnancy until birth. The antiviral drug, tenofovir is available at low cost in many countries of the world for less than US$3 per month.
• In settings where HBV viral load testing is not available, WHO recommends the use of an alternative low cost test (HBeAg) to determine whether a woman is eligible for preventive antiviral therapy.

In countries that have already achieved high coverage of hepatitis B immunization, including timely birth dose, routine testing for HBV infection among pregnant women and antiviral prophylaxis for those in need is an additional opportunity to prevent onward transmission from mother to child. 

“Stopping vertical transmission of HBV is a key pillar of the global ‘triple elimination’ initiative, which seeks to eliminate mother-to-child transmission of three infections that are prevalent in low- and middle-income countries: HIV, syphilis and hepatitis B virus,” added Dr Doherty.

Eliminating mother-to-child transmission of HBV is also an important stepping stone for reaching the targets of WHO’s global hepatitis strategy, which aims to reduce new hepatitis infections by 90% and deaths by 65%, compared to 2015 levels.

The COVID-19 pandemic jeopardizes future progress

COVID-19 threatens to hamper progress in eliminating HBV. According to a new modelling study conducted by Imperial College London in collaboration with WHO, disruptions to the hepatitis B vaccination programme due to the pandemic could have a serious impact on efforts to reach the targets of the global strategy.

Under a worst-case scenario, with high levels of disruptions of both the birth dose and childhood HBV immunization (by 60% and 20% for one year respectively), as well as a delay and slow recovery in the expansion of the vaccination programme towards the planned 2030 WHO-targets in the post COVID-19 period, there would be a projected 5.3 million additional chronic HBV infections among children born between 2020 and 2030 and 1 million additional HBV-related deaths among those children later on.  Thus, missed opportunities now to prevent new HBV infections will have a long-lasting and life-impacting effect.

The Dubai Health Authority (DHA) sees the reopening of airports, aggressive testing and sanitization, and resumption of elective surgeries and other healthcare services as clear indicators of Dubai’s readiness to restart health tourism in the emirate.

Prior to the pandemic, Dubai has projected that the sector would contribute about 500,000 visitors in the emirate by 2021. An increasing number of tourists around the world are now waiting to travel for health or medical reasons to Dubai and may soon resume their impending flight plans following the emirate’s lifting of entry restrictions to tourists and visitors due to the COVID-19 pandemic. In this regard, the Health Tourism Department recently held a webinar themed ‘Dubai Leads the Great Comeback: DXH welcomes the world to exceptional health experiences’ to announce the sector’s readiness to welcome health tourists.

The Dubai Government’s leading efforts to strongly implement precautionary measures to curb the spread of COVID-19 in coordination with national health authorities, as well as its high-level engagement to help patients recover, had put the emirate’s advanced healthcare sector once again in the global spotlight.

The webinar, attended by key stakeholders from the tourism and health sectors and led by key speakers from the Dubai Corporation for Tourism and Commerce Marketing (DCTCM), and private hospitals which are members of the DXH, further shed light on how the country is planning to make Dubai a destination of choice for health tourists amidst the current situation as well as the strategic measures of the authorities to ensure patient safety upon health tourists’ arrival.

Dubai – medical tourism hub

Dr. Marwan Al Mulla, CEO - Health Regulation Sector, Dubai Health Authority, said, "As we all know, the world is currently facing an unprecedented crisis - one that has managed to impact various industry verticals, including health tourism. However, the government's commitment and effort to address the impact of the pandemic has put us on the path to recovery rather soon. In fact, the exemplary actions of the government have allowed the UAE to be ranked as one of the safest nations during the pandemic—number one in the Arab region and one of the world's top ten in managing COVID-19."

He added: “Amidst the pandemic spread and the implementation of restrictions for businesses and individuals alike, Dubai’s healthcare sector has efficiently provided virtual assistance in licensing, including the provision of telemedicine which many hospitals have immediately adopted at the height of the situation. We are proud of the performance of the healthcare sector during that time. As some of the last patients have left from hospitals, we are resuming normal services for both inpatients and outpatients. This experience has been incredible for Dubai and a true test to the strength of our healthcare system.”

"The Dubai Health Authority has licensed a total of 3,397 health facilities in the emirate, 45 of which are newly established during the first half of 2020. Dubai Health Experience remains committed to supporting the emirate’s journey to become the most preferred global health tourism destination and a hub for top-accredited healthcare facilities," concluded Al Mulla.

The Health Tourism Department has raised its efforts to support Dubai in its journey to become the most preferred global health tourism destination and a hub for top-accredited healthcare facilities. It plans to boost its efforts post COVID-19 focusing on preventive and alternative health practices such as ayurveda, homeopathy, and yoga. Statistics have shown that the UAE’s wellness and spa travel market caters well to both inbound and domestic travellers, which is about 15 per cent of the total tourism market.

Home care, also referred to as domiciliary care, social care, or in-home care, is medical treatment provided at home by licensed healthcare professionals. With most healthcare services, such as elective surgeries in the United Arab Emirates (UAE) suspended to accommodate COVID-19 patients, home healthcare field has come to the fore to help patients with chronic diseases and other urgent medical needs.

Omnia Health Insights spoke to Mohamed Khalaf, Director – Transformational Health Practice, Frost & Sullivan, Middle East, to get his take on what is driving the home care services market in the UAE.

How has home care become an essential strategy to face COVID-19 and similar future crises?

There is increased awareness amongst patients and their families, and initiatives by public and private sectors developed over a short time have contributed to this. Post-COVID-19, it is expected that the dependence on home care through both public and private sectors will increase. This will further be aided by the current technological advances, such as 5G, ERP systems, unified medical records and digital platforms, promoting an enhanced environment for home care delivery.

It is essential, however, to have a comprehensive national corporate governance system in place to establish policies and guidelines to organise service delivery with an appropriate financing mechanism while protecting patients’ records. The workforce will play an essential role during the execution phase; training will be crucial to ensure a complete understanding of the social care requirements and development of family support.

What is the current state of home care services in the UAE?

The current home care utilisation in the UAE is low compared to other countries. This is mainly due to the nature of the population in the country, where the elderly (people aged 65 and older) make up a low percentage in comparison to other Eastern countries. Further, expats account for 90 per cent of the population, and they prefer to perform major surgeries and post-acute rehabilitation in their home countries.

Long-term care and chronic patients are the focus of the healthcare authorities in the UAE over the past decade. There have been more service provisions at home for patients under the eligibility criteria and certain conditions allowing long-term care patients to receive proper care at home. However, in 2019, there were more than 25 million outpatient visits and ~800,000 in-patients who received care within a hospital. Post-COVID-19, we expect to see a gradual transfer of these patients from a hospital set up to home care to ensure effective delivery of care to citizens in the UAE.

What is the future of home care services in the country?

Post-COVID-19, the healthcare system is expected to witness significant changes, with more reliance on digital infrastructure. Digital transformation allows the delivery of care through seamless processes. Establishing comprehensive, virtual home care requires major foundations and infrastructure, including a digital platform, healthcare protocol, policies, guidelines, financing and monitoring. This will allow healthcare services to incorporate virtual care and connected homes.

However, certain concerns related to security threats, privacy breaches, rapid technological changes, and interoperability will need to be addressed or we may see delays and an increase in the cost of digital transformation in the UAE.

One of healthcare’s biggest challenges today is that to what degree do health systems have the digital capacity to engage every consumer and every citizen globally, when and where needed to help them stay healthy. This includes helping to prevent people from getting infected by COVID-19 or managing other chronic conditions. This is the heart of where digital health ecosystems play an important role.

The way in which healthcare is delivered was already evolving at a rapid pace, but the COVID-19 crisis has accelerated this transformation. Digital health technology has played a crucial role in the fight against the novel Coronavirus.

The pandemic saw several countries use integrated digital technology into government-coordinated containment processes such as testing and contact tracing, which, in certain instances, helped in the early flattening of incidence curves.

A recent report by consulting firm McKinsey highlighted that US$250 billion in healthcare spending in the U.S. could shift to virtual care models in the wake of the pandemic. Moreover, a study by non-profit group FAIR Health suggested a 4,000 per cent increase in telehealth claims across the U.S.

This phenomenon is not just restricted to the U.S. but has been seen all over the world. The upscaling of virtual care capacity and telehealth, in the wake of the pandemic, has given rise to a number of new digital health tools such as self-triaging and contact tracing.

“The pandemic has accelerated, detonated the implementation of many technological solutions that had been long struggling to prove their value! That struggle though, mostly came from the lack of vision by the “gatekeepers” of our healthcare systems,” said Dr. Rafael Grossmann, renowned as the world's first surgeon to use Google Glass.

Below we take a look at technologies that are continuing to have an impact in the global effort to curb COVID-19:

Telemedicine

Telemedicine has been an effective tool in containing the spread of COVID-19. Virtual care platforms, using video conferencing and digital monitoring, have been used worldwide to reduce exposure to Coronavirus. When implemented effectively, virtual care can increase healthcare access, but possible risks could include misdiagnoses, privacy breaches, etc.

Despite the concerns, the pandemic has shown that there is an important duty today to use technology to make healthcare accessible to anybody. The systems can be designed to assist at an early stage, where it is possible to diagnose a disease earlier on or even help patients with chronic diseases manage their condition.

In Canada, for instance, video visits have reportedly increased from approximately 1,000 visits per day in February to 14 000 per day by mid-May. While in the UAE, a virtual doctor chatbot was launched by the UAE Ministry of Health and Prevention (MOHAP) to assess potential coronavirus cases in the country.

At the recently concluded virtual expo Omnia Health Live, Prof Tim Pawlik, Chair of Surgery, Ohio State University Wexner Medical Center, shared that, previously, his hospital was doing fewer than a 100 telemedicine visits but today they are conducting almost 14,000 of these a month, both telephonic and tele-video. “This has revolutionised how we are interacting with our patients. I believe that many of the patients will continue to prefer these virtual visits,” he said.

However, Prof Pawlik shared that this has raised a couple of issues such as how can hospitals maintain the experience and educational experience of their trainees. The other challenge has been that some individuals might not have access to broadband Internet, especially those who are of a lower economic socio status. “We have to be cognisant about how we roll out telemedicine and telehealth relative to certain social determinants of health,” he stressed.

AI in diagnostics

Artificial Intelligence (AI) has been an asset that has facilitated rapid diagnosis and risk prediction of COVID-19. For example, in China, a cloud-based AI-assisted CT service has been used to detect COVID-19 pneumonia cases. This technology reportedly processes CT images in seconds, differentiating COVID-19 from other lung diseases and speeds up the diagnostic process substantially.

Moreover, Sonavi Labs’ Feelix, an AI-enabled digital stethoscope and software to diagnose respiratory conditions, has been to researchers at the American Hospital in Dubai, to build a reference library of clean audio files for the COVID-19 disease.

Ellington West, CEO & Co-Founder, Sonavi Labs told Omnia Health: “We hope that by collecting and analysing this data, we will be able to identify the specific acoustic signature of COVID-19, in the same way, we have been able to validate the technology on pneumonia. If we are successful in validating our classification algorithm on the COVID-19 virus, then we will be able to train all of our devices to detect the disease, providing a dry digital diagnostic solution anyone can use that is rapid, accurate and sustainable.”

3D printing

The Coronavirus crisis put immense pressure on healthcare workers and hospitals have been overwhelmed by the volume of patients and the lack of personal protective equipment (PPE), creating a high risk for contracting COVID-19. PPE includes facemasks, gloves, eye protection, and clothing. Hospitals have also faced a shortage of COVID-19 testing swabs and kits, respirators, and ventilators.

According to Dr Paul Frisch, Chief of Biomedical Physics and Engineering, Memorial Sloan Kettering Cancer Center, New York City, 22 per cent of the patients that showed at the hospital required ICU level care while 79 per cent of ICU patients required ventilation.

He said: “At our hospital, we have a 3D printing laboratory running six printers. During the crisis, certain things that came up in the design and development stages. We had a feeling that there would be a shortage of ventilators and supplies such as nasal swabs, N95 masks, and we had to address that in a variety of ways and leveraged our 3D printers to build a stock of these and sent it to the U.S. Food and Drug Administration (FDA) for approval so that they could be used in times of need.”

Many companies were also at hand to address these shortages. For example, NASCAR has a research and technology centre that uses 3D printing to build composite parts for the next generation of stock cars. But in light of the pandemic, the company is using its 3D printers to churn out PPE such as face shields for healthcare workers. Also, Ford worked with GE Healthcare to build air-pressured ventilators, and Chevrolet (General Motors) has partnered with Ventec Life Systems to build ventilators.

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Contact tracing apps

Tools such as migration maps and contract tracing apps, which use mobile phones, have allowed collecting real-time data on the location of people. With this data, machine learning models are being developed to forecast the transmission of SARS-CoV-2 and guide border checks and surveillance.

However, contact tracing applications are not without pitfalls. The apps have raised privacy concerns because some need to store user data on central servers and there is a chance of this information being misused. Also, researchers at Oxford University in the UK, suggested that 60 per cent of a country's population would need to use a contact tracing application for it to be an effective strategy.

Robotics

Robots are becoming commonplace in healthcare today, even more so during the pandemic, as they don’t cough or get ill! Today, robots that are being built can handle multiple different scenarios, such as in assisting and amplifying human efforts in different care tasks. Inside hospitals, robots can be deployed for disinfection, medicine and food delivery, vital signs monitoring, thus helping to significantly reduce the infection risk of personnel.

An interesting example is Heriot-Watt’s Alana system that has been designed to deliver health-related information and support via conversational AI, during the pandemic. Some of its important features are that it can detect myths and misinformation and offers mental health advice. It also only outputs validated sources of information such as from the World Health Organization (WHO).

Digitalisation

In a period where staffing shortages are hampering the efforts to contain COVID-19, recruitment has become a major challenge. As the pandemic intensifies, TrueProfile.io – a provider of primary source verification (PSV) solutions – provides access to their database of job-seeking, verified healthcare staff in the GCC via TrueProfile.io Recruiting. It enables hiring managers to access a digital pool of verified medical staff in the GCC who are actively seeking new opportunities.

Additionally, the use of blockchain-enabled platforms has helped in enabling early detection of epidemics, fast-tracking drug trials, and impact management of outbreaks and treatment. The technology has also proven its success in supply chain management and could be beneficial in tracking and tracing medical supply chains.

“The whole push towards digitalisation in healthcare just got accelerated five years from this virus. Where we were six months ago versus where we’re going to be in a year and a half; that’s two years of hyper-accelerated digital development that normally would have taken five to 10 years. We’re going to see a lot more companies developing apps for patient portals,” said Dr Jeff Staples, Chief Operating Officer, United Family Healthcare.

“COVID-19 has been able to accelerate the adoption of many technology solution in the healthcare that have been there for a while including the automation of business processes,” Dr Osama AbouElkhir, CEO of TachyHealth, added. “We saw a wider acceptance and adoption for the future-working environment where machines, algorithms, and robots empower and augment the humans to improve their effeciency, productivity, and wellbeing.”

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Internet of Medical Things (IoMT)

Several advances in technology are driving innovation in medtech that has led to an increase in the number of connected medical devices that can generate, collect, analyse and transmit data. The data, along with the devices themselves, are creating the IoMT – a connected infrastructure of medical devices, software applications and health systems and services.

In China, for example, 5G network powered telemedicine consultations and case discussions offered by experts have allowed for medical treatment and responses to COVID-19. Therefore, there is bound to be accelerated development of the 5G telemedicine in the country, as both doctors and hospital management are leveraging these technologies to reach patients, especially in remote areas.

“We are witnessing a major shift in the healthcare sector as the adoption of IoMT brings forward medical devices and equipment connected to the internet. This has moved us into an era of continuous healthcare enabling real-time monitoring of medical data,” stressed Marwan Abdulaziz Janahi, Managing Director of Dubai Science Park.

Big data

“We are seeing right now, in the Middle East especially, a huge demand for big data to make decisions, to track patients, and to track the spread of the epidemic using maps. I would say that big data is a new trend that will transform the healthcare industry in the coming years,” said Khalid Ghaloua Adine, Director, Digital Healthcare Industry, Etisalat.

The pandemic has brought new big data-driven practices of infectious disease surveillance to the forefront of efforts to track cases in real-time. The COVID-19 trackers pull data from sources around the world and are helping healthcare workers, scientists, epidemiologists and policymakers’ aggregate information. This will help in information sharing among hospitals, governments and countries in understanding various treatment modalities, and identifying those treatments that are having a better impact.

“This pandemic showed the real power of centralised data for the swift identification of public health risks and emergency preparedness,” highlighted Atif Al Braiki, CEO of Abu Dhabi Health Data Services.

COVID-19 immunity passports have been touted as a possible way to help take the strain off increasingly stretched healthcare systems and shrinking economies. However, there is mounting anxiety that technologically enabled responses to COVID-19 could be detrimental for data privacy. Despite this, according to TrueProfile.io, a leading provider of primary source verification (PSV) services, blockchain offers some hope for alleviating these privacy fears, setting the stage for the technology to finally breakthrough into the mainstream.

Immunity passports aim to link an individual’s identity with their COVID-19 test status, opening up a way out of lockdown restrictions for those that are proven to be immune to the disease. This means that any immunity passport would rely on antibody tests – which are intended to show whether someone has recovered from the infection – to then provide certification that a person is immune and cannot catch the virus again.

By the very nature of COVID-related immunity passports, they are likely to contain sensitive and personal health data. This has made them a hot topic when it comes to data privacy, with many concerned about how the data will be stored and who will have access to the data. This is where blockchain – a decentralising technology typically associated with Bitcoin and cryptocurrency – can be used to ensure data governance and that user privacy will not be compromised.

René Seifert, Co-Head at TrueProfile.io, explained: “A blockchain-enabled digital immunity passport could be viable if end-users provide proof of ID before testing and a permanent ‘digital fingerprint’ of the certificate is placed on the blockchain, which is used by a verifier, such as an employer, to check authenticity. Crucially, as test results are stored as a ‘fingerprint’, this offers a form of encryption and makes sure that the digital certificate provided to the end-user is secure and tamper-proof by design, which means it is unalterably linked to their identity. For those more concerned about the data security, as each ‘fingerprint’ is individual and does not reveal any information about whom the document belongs to, it also safeguards the information it contains.

“The fundamental assumption in blockchain is that a centralised data monitoring or validation is not required among a network of distributed databases because some pre-agreement about data validation has been conducted. This makes it ideal for the immunity passport use-case, as no central party has control over its content, giving the end-user complete control of how their health data is being used. Utilising this technology could also alleviate concerns over a wider surveillance infrastructure (including a contact tracing app) that will collect data beyond the purposes of determining people who are potentially immune to COVID-19. Ultimately, implementing this technology into such an important and urgent issue would likely bring it into the mainstream consciousness and out of the shadow of Bitcoin and the world of cryptocurrency.”

How will a blockchain-enabled immunity passport work?

Despite the privacy guarantees that a blockchain-enabled immunity passport can afford, René also believes that a strong dose of caution needs to be kept in mind before developers get ahead of themselves. The World Health Organisation (WHO) has consistently warned about a lack of scientific evidence for COVID-19 immunity, saying those who wrongly believe themselves to be immune could get reinfected or transmit the disease further. For René, this has the potential to derail the concept of digital immunity passports entirely.

He concluded: “At present, the biggest barrier to immunity passports is the testing itself. Firstly, immunity tests need to possess higher levels of sensitivity and specificity, which are essential measures to express the rate of false negatives and false positives of a result. More worryingly, due to the novelty of the disease, scientists don’t have enough data on the body’s immune responses. This means that we simply don’t know how long someone remains immune to COVID-19 – or even if they can become immune at all in the case of asymptomatic patients.

“As such, a more sensible line of action would be to follow the science. For a blockchain-enabled immunity passport to truly work effectively and be taken seriously, it is crucial that COVID-19 tests not only have high levels of sensitivity and specificity, but any antibody test is proven to show that end-users cannot get infected again. However, this should not mean that governments and healthcare bodies abandon the development of blockchain-enabled immunity passports altogether, as the time may come when this sort of technology could be highly effective and help keep citizen health data secure and decentralised.”

The responsibility of employee physical and mental wellness is playing an ever-increasing role in the corporate agenda. For some that responsibility is taken begrudgingly, materialising as token gestures and initiatives. For others, the wake-up call has been answered and leading organisations are stepping up to their responsibility for employee health and well-being. Below are five key areas to create a positive corporate environment.

Provide support in uncertain times

Having business savvy will only get you so far as a leader. Understanding and empathy are two crucial traits to master, especially during a time of unprecedented challenge such as the COVID-19 pandemic. The strict lockdown measures introduced across the globe, understandably, created an atmosphere of uncertainty and anxiety – employees expressed fear for their job security and the health and safety of their loved ones.

Mental well-being is an issue that is often glossed over, but it can have a detrimental impact on staff health. It is imperative that companies step up to the mark, providing clarity and support to those who need it. Having access to trained specialists such as psychologists can be a godsend for individuals or families that are struggling. In Fine’s case, the company immediately set up an Employee Assistance Program, which offers a 24/7 hotline in English, Arabic, French, Urdu and Hindi. A commitment to employee mental health and peace of mind will go a long way.

Tip the scales of the work-life balance

If the pandemic has taught us one thing, it is the importance of spending time with family and loved ones. Forced into lockdown, many have re-evaluated how much time is spent in the offices and away from home. While supporting a back-to-business mentality is positive and, undoubtedly, many employees will be eager to get back, don’t be afraid to adapt to the opportunity presented.

The ability to work from home even in a post-COVID-19 world will be a massive boon for employees with families. During the lockdown, working from home enabled staff to feel safe and protected during a time of uncertainty. Ensuring the continuation of that feeling, even though offices are open, will play a huge part in mental health and well-being.

As an organisation, you need to be agile in pinpointing and reacting to the needs and wants of employees. Adapting fast and initiating a change in policy is the best and only way to show you are listening. At Fine, we’ve wasted no time in updating our policy from “Work from Home” to “Work from Anywhere”.

Build a diverse and inclusive workforce

If building a diversified workforce isn’t at the top of your organisation’s priority list, then it should be. Creating equal opportunities regardless of gender, race or creed is fundamental in creating a positive work environment where everyone feels like they have a voice and have equal job and salary opportunities.

Speaking from my experience at Fine, the introduction of initiatives that empower women, closing the gender pay gap and defining career development and promotions have grown from initiatives to being embedded in the company culture. As a result of this, female representation in leadership roles has grown from 0 to nearly 30 per cent over the past three years.

Creating diversity and championing employees regardless of their differences needs to be a core value and a pillar which your company sits on. Only then will you see it pay-off.

Ensure access to exercise

“If you don’t have your health, you don’t have anything.” That’s not just a company mantra, it is a theme carried throughout Fine Hygienic Holding and a phrase I personally associate with. Physical health plays a large role in employee well-being, and not only for the obvious reasons. It is essential in mental health and the work-life balance.

Providing a comprehensive wellness plan for staff by offering access to gyms, exercise equipment and activities will not only create an all-inclusive work environment but also open up avenues to physical well-being that might not be readily available outside of office hours. Gym co-payments, promoting office-wide fitness challenges and wellness sessions and now free virtual exercise classes are all excellent ways of promoting physical health.

We went one step further at Fine and built a comprehensive wellness centre on our UAE premises, which includes a fully equipped gym with 16 new machines, yoga room and high-intensity track. That’s now supplemented by a new machine, the FitStop, the first of its kind in the Middle East, which is designed with the sole purpose of reducing sitting disease.

Fine's Wellness Center

Create a family-friendly environment

Putting employees in a position where they choose between becoming a parent or their career will never garner a positive result; the company will always lose out. Creating an inclusive and family-friendly environment where the choice to become a parent isn’t penalised protects yourself and employees. By embracing and catering to a more personal side of your staff’s lives, you go beyond the employer-employee relationship.

While it may seem cliché for a company to say: ‘we are a family’, I truly believe the greatest success is built on a foundation of invested and looked-after employees. In Fine, this has manifested in a number of policies that benefit new moms and dads. At 16 weeks full pay with the option of an additional 16 weeks unpaid leave, our maternity leave goes above and beyond the mandated amount by the International Labor Organization. And for paternity leave, dads can take three weeks full pay and an additional week without pay.

This is bolstered further by flexible work hours for new moms, an incremental return to work policy and the option to work part-time. Why make employees choose between working and family when you have the ability to accommodate both?

Lafferty is the CEO of Fine Hygienic Holding. With experience as an Olympic Coach, and more than 30 marathons and a Philippine national powerlifting championship to his name, he has applied a sporting mentality to business, and it has paid dividends to employee fitness and mental health.