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      Adoption of Digital Technologies in Health Care During the COVID-19 Pandemic: Systematic Review of Early Scientific Literature

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          Abstract

          Background

          The COVID-19 pandemic is favoring digital transitions in many industries and in society as a whole. Health care organizations have responded to the first phase of the pandemic by rapidly adopting digital solutions and advanced technology tools.

          Objective

          The aim of this review is to describe the digital solutions that have been reported in the early scientific literature to mitigate the impact of COVID-19 on individuals and health systems.

          Methods

          We conducted a systematic review of early COVID-19–related literature (from January 1 to April 30, 2020) by searching MEDLINE and medRxiv with appropriate terms to find relevant literature on the use of digital technologies in response to the pandemic. We extracted study characteristics such as the paper title, journal, and publication date, and we categorized the retrieved papers by the type of technology and patient needs addressed. We built a scoring rubric by cross-classifying the patient needs with the type of technology. We also extracted information and classified each technology reported by the selected articles according to health care system target, grade of innovation, and scalability to other geographical areas.

          Results

          The search identified 269 articles, of which 124 full-text articles were assessed and included in the review after screening. Most of the selected articles addressed the use of digital technologies for diagnosis, surveillance, and prevention. We report that most of these digital solutions and innovative technologies have been proposed for the diagnosis of COVID-19. In particular, within the reviewed articles, we identified numerous suggestions on the use of artificial intelligence (AI)–powered tools for the diagnosis and screening of COVID-19. Digital technologies are also useful for prevention and surveillance measures, such as contact-tracing apps and monitoring of internet searches and social media usage. Fewer scientific contributions address the use of digital technologies for lifestyle empowerment or patient engagement.

          Conclusions

          In the field of diagnosis, digital solutions that integrate with traditional methods, such as AI-based diagnostic algorithms based both on imaging and clinical data, appear to be promising. For surveillance, digital apps have already proven their effectiveness; however, problems related to privacy and usability remain. For other patient needs, several solutions have been proposed, such as telemedicine or telehealth tools. These tools have long been available, but this historical moment may actually be favoring their definitive large-scale adoption. It is worth taking advantage of the impetus provided by the crisis; it is also important to keep track of the digital solutions currently being proposed to implement best practices and models of care in future and to adopt at least some of the solutions proposed in the scientific literature, especially in national health systems, which have proved to be particularly resistant to the digital transition in recent years.

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          Most cited references147

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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            Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period

            It is urgent to understand the future of severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) transmission. We used estimates of seasonality, immunity, and cross-immunity for betacoronaviruses OC43 and HKU1 from time series data from the USA to inform a model of SARS-CoV-2 transmission. We projected that recurrent wintertime outbreaks of SARS-CoV-2 will probably occur after the initial, most severe pandemic wave. Absent other interventions, a key metric for the success of social distancing is whether critical care capacities are exceeded. To avoid this, prolonged or intermittent social distancing may be necessary into 2022. Additional interventions, including expanded critical care capacity and an effective therapeutic, would improve the success of intermittent distancing and hasten the acquisition of herd immunity. Longitudinal serological studies are urgently needed to determine the extent and duration of immunity to SARS-CoV-2. Even in the event of apparent elimination, SARS-CoV-2 surveillance should be maintained since a resurgence in contagion could be possible as late as 2024.
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              Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing

              The newly emergent human virus SARS-CoV-2 is resulting in high fatality rates and incapacitated health systems. Preventing further transmission is a priority. We analyzed key parameters of epidemic spread to estimate the contribution of different transmission routes and determine requirements for case isolation and contact-tracing needed to stop the epidemic. We conclude that viral spread is too fast to be contained by manual contact tracing, but could be controlled if this process was faster, more efficient and happened at scale. A contact-tracing App which builds a memory of proximity contacts and immediately notifies contacts of positive cases can achieve epidemic control if used by enough people. By targeting recommendations to only those at risk, epidemics could be contained without need for mass quarantines (‘lock-downs’) that are harmful to society. We discuss the ethical requirements for an intervention of this kind.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                November 2020
                6 November 2020
                6 November 2020
                : 22
                : 11
                : e22280
                Affiliations
                [1 ] Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
                [2 ] Department of Italian and Supranational Public Law University of Milan Milan Italy
                [3 ] STLab ISTC-CNR Rome Italy
                [4 ] IRCCS Istituto Ortopedico Rizzoli Bologna Italy
                Author notes
                Corresponding Author: Erik Boetto erik.boetto@ 123456gmail.com
                Author information
                https://orcid.org/0000-0001-7331-9520
                https://orcid.org/0000-0002-2509-159X
                https://orcid.org/0000-0001-9810-0736
                https://orcid.org/0000-0003-2928-9496
                https://orcid.org/0000-0002-2842-9824
                https://orcid.org/0000-0002-3257-6552
                Article
                v22i11e22280
                10.2196/22280
                7652596
                33079693
                f7e4d20e-8b59-43b2-9d6a-5af5962c6d18
                ©Davide Golinelli, Erik Boetto, Gherardo Carullo, Andrea Giovanni Nuzzolese, Maria Paola Landini, Maria Pia Fantini. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.11.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 7 July 2020
                : 20 July 2020
                : 25 July 2020
                : 15 September 2020
                Categories
                Review
                Review

                Medicine
                covid-19,sars-cov-2,pandemic,digital heath,review,literature,mitigate,impact,ehealth
                Medicine
                covid-19, sars-cov-2, pandemic, digital heath, review, literature, mitigate, impact, ehealth

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