August 2020

DIGITAL HEALTH

Tackling COVID-19 Pandemic through Integrating Digital Technology and Public Health: Linking Experiences in to the World CONTENT

3 Executive Summary 7 Acknowledgement 8 Background 14 Digital Technology Relevant Policy 24 Fast Response 37 Epidemiological Studies 43 Diagnosis and Treatment 71 Supportive Activities 108 Long-term Management 124 Comprehensive Disease Control System 134 Conclusion and Reflection 140 Author Team Executive Summary

The Covid-19 pandemic has turned into a roles of public and private sectors and global public health crisis, evolving at an digital technologies played throughout unparalleled speed and scale, debilitating economies and health systems across the success. Covid-19 outbreak. The speed globe. It became imperative for with which China has dampened the governments and organizations across the impact of Covid-19, from the identification globe to take immediate actions to of the first case, to outbreak, to protect their people. containment, to recovery and resumption of a post-Covid-19 living, is remarkable. China was the first country impacted by This progress, albeit via drastic measures, the novel virus, facing rising infection is unprecedented. The roles of public and rates as it urgently worked to contain and private sectors and digital technologies control the spread. While fear and panic played throughout this journey were government, from central to local leaderships, rapidly mapped out their As the Covid-19 pandemic continues to outbreak response strategies and devastate many countries across the world, coordinated their epidemic control plans. documenting and sharing experiences of Technology, especially digital technology, effective preventative actions and was an instrumental part of their strategy containment strategies for the outbreak implementation. Vast technology have become crucial in fighting against infrastructure quickly took action, the global outbreak. As such, the report deploying tools for information access wishes to humbly offer governments and and dissemination, population tracking business leaders around the world with and contact tracing, access to daily some observations and insights from necessities, and many more. -19, to further enable effective response to After close to three months of fight the virus. containment measures, rapid mobilization of medical resources, and stringent Through a combination of desktop -19 research and key informant interviews outbreak somewhat stabilized. Today, used in this study, the report documents China is the first market in the world to and analyses the impact and implications recommence business following the of government actions and digital Covid-19 outbreak. The speed with which technology solutions. The report offers an China has dampened the impact of Covid- in-depth understanding of the actions and 19, from the identification of the first case, strategies implemented by the to outbreak, to containment, to recovery government, the roles digital technology and resumption of a post-Covid-19 living, played, the technologies used, and the is remarkable. This progress, albeit via impact made across six outbreak response drastic measures, is unprecedented. The categories. The categories are: fast

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response, epidemiological studies, treatment capacity and efficiency of diagnosis and treatment, supportive frontline healthcare providers and activities, long term management and alleviated the shortage of medical comprehensive disease control system. In services and resources. total, the report delves into 12 digital technology case studies and provides a 4) Established a platform for efficient comprehensive view of how each case communication between the enabled and empowered the public and government and the general public, the private sectors, the health system, the establishing reliable platforms for general public in helping to flatten the epi medical supplies and donations, and curve, based on their respective provided supp-ort for the more categories. The roles and impact of the vulnerable and elderly population digital technology interventions are groups. summarized into the following five 5) A powerful management tool in aspects: supporting work and production 1) Improvement of quality and resumption, and community efficiency in governmental decision- management, becoming an making in response to public health indispensable in helping the emergencies by assisting the government to reopen the economy, government in managing epidemic accelerate social and individual prevention and control, such as recovery. integrating data, analyzing outbreak The impactful applications of digital progression, identifying and tracking technology in the Covid-19 pandemic high-risk groups. successfully helped mitigate and 2) Accelerated the research of gene overcome many hardships. Through many sequencing and protein structure of years of expertise accumulation and Covid-19, the prediction of the scale of technology developments and reforms, transmission and epidemic trends, the solutions are able to effectively help improved understanding of the virus , fight against the pandemic. The report enhanced the diagnosis and treatment documents the key success factors across capabilities of the medical system, and three levels: 1) government, 2) society, and assisted pharmaceutical companies to 3) enterprise (See below Table). accelerate the development of drugs The pandemic accelerated digital and vaccines. innovation in emergency response 3) Realized telemedicine and remote management. From outbreak to health management, minimizing containment and to recovery, digital cross-infection among patients, technology solutions improved effectively improved the diagnosis and effectiveness and efficiency in information

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dissemination, population tracing, health from the government levels to guide services, resources mobilization, daily and control the pandemic responses. living and business continuity, community management, and many more. However, Although there are still challenges ahead, in order for all of the aforementioned as the Covid-19 battle is far from being aspects to be supported via digital won, digital technology has become a technology, few conditions are critical in powerful and indispensable tool for the ensuring the solutions can be applied. The government, the health system, report describes four key necessary businesses, and general public. The aspects: solutions continue to help different stakeholders to stay connected and 1) User adoption: The extent of the informed, pushing forward towards application of digital technology in recovery. pandemic prevention and control is dependent on the level of public Finally, the report is not meant to be a awareness, acknowledgment, and recipe for success. Rather, a reference and cooperation. an inspiration for the regions in need. Understanding the requirements and 2) Technological foundation: The benefits these digital technology technological foundation is essential interventions brought, assessing the to promote digital response. Over the feasibility and conditions for replicability past two decades, China has would be informative to countries in experienced large-scale digital different stages of the pandemic. As transformation. The accumulation and Covid-19 pandemic transmits across usage of these technologies borders, impacting the most vulnerable, prompted the rapid participation of we hope this report can inspire more digital technology in the fight against collaborations across market, geographic, the pandemic. and cultural boundaries.

3) Data foundation: The informatization of data is the most basic element for the application of digital technology. The ability to aggregate and analyze the various sources of data, while ensuring data security and privacy provided a foundational environment for the epidemic response using digital technology.

4) Governmental support: The Covid-19 crisis has been a battle that requires unity among all. It requires leadership

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Levels Key Success Factors

At the onset of the outbreak, National Health Commission clarified the important role of information system in epidemic prevention and control. In President Xi Jinping's speech on February 14, 2020, he reinforced the importance for local authorities and departments Policy Guidance to apply digital technology in strengthening the epidemic responses. This reinforcement laid a solid foundation for promoting the in-depth application of digital technology in epidemic prevention and control. Government During the outbreak, the Chinese government continued to proceed with various prevention and control measures to ensure the smooth implementation of the digital technology. For example, the National Health Security Administration and the National Health Ground Support Commission issued relevant guidelines at the end of February, announcing that the "Internet Plus" follow-up services for common and chronic diseases were to be included in the scope of medical insurance payment. In recent years, many cities in China are exploring the establishment of medical information systems. In the process of Foundation of participating in the fight against Covid-19, many medical Information technology companies, such as We Doctor, United Imaging, rebuilt System and connected original information systems, and effectively Development ensured the rapid successful implementation of the digital Social solutions. Since China entered the Internet era at the beginning of the 21st century, digital technology has been used in many aspects of society, such as social media, ecommerce, and mobile payment. User Trust This development become the foundation for digital technology to quickly obtain user participation and cooperation during the fight against Covid-19. Faced with the evolving outbreak situation, many Chinese technology companies have reacted quickly. Enterprise leaders immediately mobilized their employees to fight against the Quick Decision- epidemic, and many companies donated many resources such as Making and Input hardware equipment and software technologies, unconditionally to facilitate the rapid spread and support the overwhelmed health system. Enterprise Technology accumulation is an important success factor for many technology companies when providing digital solutions for combating Covid-19. In the event of a public health emergency, in Technology order to ensure that various types of digital technology can be Accumulation applied rapidly and effectively to support prevention and control measures, the company's own accumulation of technology and application experience become critical.

Table. Key success factors at various levels

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The report is part of the project Tackling In the process of writing this report, the Covid-19 Pandemic through Integrating author team conducted numerous in- Digital Technology and Public Health: depth interviews with several industry Linking Experiences in China to the experts and leaders, without whom much World, conducted by ACCESS Health of the content in the report would not exist. International and fully supported by The The author team would like to express Rockefeller Foundation. deep appreciation for our industry partners in China, whose feedback and insights The author team would like to sincerely have been invaluable. thank The Rockefeller Foundation and its Asia Regional Office team for their mission In reviewing and refining the report, the and their belief in the importance of author team would like to thank our sharing experiences and knowledge to ACCESS Health International colleagues, places in need. Especially during a time of Anna DIRKSEN and Tess RECKINGER, as crisis, such as the Covid-19 pandemic, well as our ASK Health colleagues Wenting enabling and encouraging timely PU, Sara SHEN and Zhun (Mitchell) MENG knowledge and know-how transfers from for their support, time and effort. one region to another is empowering and priceless. Finally, the author team is especially thankful for the ASK Health team members The author team is grateful for Dr. Gauden based in China, namely, Qun LI, Rui GU, GALEA, World Health Organization (WHO) Shuaiqi JIA, Shanshan JU, Chunting LU, and Representative in China, and Ms. Mengji Yue XU, for their contribution to the CHEN, WHO Digital Health Project collection of primary data and secondary Manager from WHO China, for their information throughout the Chinese New ongoing support and guidance in the early development of the report. Year and at the onset of the Covid-19 outbreak in China. Without their dedication, the project would have not been possible.

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1.1 spread of Covid-19 and its resonating impact. However, systematic studies on Introduction the roles and benefits of digital solutions in pandemic surveillance and containment is currently very limited. As the Covid-19 The Covid-19 outbreak started in , outbreak continues to evolve China at the end of 2019. It became an internationally, learning and sharing international public health emergency in experiences of countries that have January 2020, and within two months, the effectively contained the spread of the outbreak was declared a pandemic by the World Health Organization (WHO). As of prevention and control process, both the July 1, 2020, Covid-19 has affected 213 central and local government leadership countries, infecting over 10.3 million have implemented an extensive use of people, and taking away more than digital technology to empower the disease 506,000 lives . As one of the first control measures and to fulfill the unmet countries severely impacted by Covid-19, needs of patients, doctors, and the public. China has taken urgent and unprecedented measures in an effort to Many technology providers have launched contain and control the scale of the new services and products to mitigate the outbreak since the beginning of the year. spread of Covid-19 and its resonating impact. However, systematic studies on Through a combination of multi-level the roles and benefits of digital solutions governmental efforts and heavy leverage in pandemic surveillance and containment of technological solutions, China has is currently very limited. As the Covid-19 demonstrably controlled a large-scale outbreak continues to evolve outbreak. The number of new cases in the internationally, learning and sharing country has dropped significantly since experiences of countries that have the beginning of March , which gave hope effectively contained the spread of the and lessons for the world to overcome the outbreak have become crucial in fighting pandemic. This has been done using a against the global pandemic. This report variety of solutions: political, social, aims to provide an in-depth understanding medical, and technological, especially the of the roles digital technology played and the different technologies used epidemic prevention and control process, throughout the epidemic. Specific both the central and local government objectives of the report include: leadership have implemented an extensive use of digital technology to • To document the actions made by empower the disease control measures makers in response to the outbreak, and to fulfill the unmet needs of patients, and the implications of each strategic doctors, and the public. decision;

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• To design an adapted integrated disease surveillance and response 1.2 framework, consists of core elements such as fast response, epidemiological Framework studies, diagnosis and treatment, supportive activities, and long-term The Severe Acute Respiratory Syndrome management; (SARS) outbreak between 2002 to 2003 • To map out the key solution providers, left a resonating impact in China and other and survey them on their current and East Asia countries. This was the last time future programs and solutions in China was paralyzed by a serious epidemic. response to the Covid-19. Collect and However, this experience accelerated the analyze the applications, impact and development of technology, e-commerce prospects of digital technologies in to healthcare sectors in China. Since SARS, times of epidemic crisis; China has gone through a socioeconomic reform and digital transformation. • To analyze the remaining opportunities, key barriers, and policy gaps for the Compared with the SARS epidemic 17 digital solutions, as well as and the years ago, digital technology has become necessary conditions to replicate these an integral element in the fight against solutions in any location Covid-19 and played an instrumental role • To generate policy recommendations in all aspects of the epidemic prevention on how digital technologies could and control. This report intends to explain augment public health in China, as well the role and impact of digital technology as recommendations to the industry solutions in the prevention and control of stakeholders. an epidemic outbreak from six aspects:

Figure 1. Framework linking outbreak response strategies to digital health interventions

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Fast Response: Epidemic outbreak 5G technology, and Internet platform can requires rapid response and timely not only help medical personnel conduct decisions made based on reliable teleconsultation for patients with Covid-19 information for effective prevention and or suspected carriers of Covid-19, but also control measures. In the case of Covid-19, provide follow-up services for the ones at fast response is even more critical. home, and for patients with other diseases Utilizing information platform, big data such as chronic diseases. Psychological analysis, and artificial intelligence consultation and counseling services were technologies, data from all channels can also offered using digital technology be rapidly collected, integrated and during the outbreak. analyzed. The information helps national and local governments quickly screen, Supportive Activities: During an epidemic identify and trace high-risk cases, monitor outbreak, aside from fast response and population flow and key locations, and diagnosis and treatment, there are many predict outbreak development, enabling other epidemic prevention and control key decision makers to make fast and measures. Digital technology played an informed decisions. integral role in activities such as artificial intelligence and data analytics in Epidemiological Studies: Understanding population tracing, Internet platforms in the virus is the one of the most critical medical personnel capacity building and steps in fighting an epidemic outbreak. medical resources mobilizing, and 5G Leveraging on technologies such as technology, Internet of Things and artificial intelligence, big data, communications platforms in community supercomputing, to conduct research on management and special groups support. the diagnosis and treatment of Covid-19, mutation prediction, transmission mode Long-term Management: As Covid-19 and transmission scale, and spectrum of stabilized and normalized, economy slowly clinical severity to help predict the trend opened and pre-Covid-19 daily life of epidemic situation and drugs and cautiously resumed in China. Through vaccines development. Early investment Internet, Internet of Things, communications platforms, companies greatly improve the epidemic response. reopened, and employees returned to work, remotely. To closely monitor the Diagnosis and Treatment: As Covid-19 is outbreak, community management and contagious and transmissible, decrease in risk management must be implemented contact and social distancing are critical stringently. Using Internet platforms, measures in containing and controlling Internet of Things, artificial intelligence, the spread. This also applies to essential big data analysis and other technologies health services, as these procedures can efficiently collect information, usually require close or direct contact. conduct screening and monitoring, and The applications of artificial intelligence, send alerts through automation.

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Comprehensive Disease Control System: A comprehensive disease control system connects disease control systems, medical institutions, residents, and communities, and offers various epidemic-related services under one service platform. This platform used digital technologies such as Internet platforms, cloud service, big data analysis, and artificial intelligence, to provide integrated information and solutions for government and general public, achieving high multifunctionality, structure efficiency, and accessibility.

In this report, a total of 12 representative cases were selected, corresponding to the framework described above. A combination of desktop research and key informant interviews was used in this study. In each chapter, we will provide a comprehensive background and the applications of digital technology in the respective category. We will showcase the relevant case study(s), offering an in- depth description and analysis of the technology, the challenges faced, as well as the key enabling factors. Finally, we will conclude the chapter with key insights, highlighting the values, challenges and limitations of the digital technology in respect to each category. Table below is a breakdown of the 6 categories, the relevant sub-categories and their respective case studies.

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Category Sub-category/Case studies

Fast Response Digital China Health

Epidemiological No Case Selected Studies

United Imaging

Diagnose and WeDoctor Treatment

Zuo Shou Yi Sheng

Information Communication DXY Public Health Training

Population Flow and Density Map

Medical Related Information Supportive Activities Tencent Social Support

Logistics Viewhigh Technology

Support for Elderly IZhaohu

Resumption Management Mininglamp Technology Long-term Management Community Management JD Digits

Comprehensive Disease Control Alibaba System Table 1. Representative case studies for six categories

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Since the emergence of Covid-19 in December 2019, the national government has been placing great importance on the essential role of information systems and digital technology in the fight against the epidemic. There are three main phases: 1) Initial applications at the onset of an epidemic outbreak, from the onset of outbreak to February 14, 2020; 2) Diversified development of digitalization in the fight against the epidemic, February 14, 2020 to May 7, 2020; 3) Applications and improvements in epidemic management during stabilized phase, from May 7, 2020 to present.

On February 14, 2020, President Xi Jinping delivered a speech at the 12th Session of the CPC Central Commission on Comprehensive Deepening of the Reform, emphasizing the crucial role of digital technology in the fight against the Covid-19 epidemic, which was especially evident during the first two phases of the outbreak. Evidently, digital technology has and continues to play a crucial role in keeping our society functional and resilient and will have a long-lasting impact beyond Covid-19.

2.1 Development of Digital Protocol on Surveillance of Novel Technology Relevant Policies in Coronavirus Pneumonia Cases (2nd Edition) and the Protocol on Epidemiological Surveys of Novel Corona-virus Pneumonia Against Covid-19 Cases (2nd Edition), as attachments to the Protocol on Prevention and Control of 2.1.1 Initial applications at the onset of Novel Coronavirus Pneumonia (2nd an epidemic outbreak, from the onset of Edition). These attachments specified the outbreak to February 14, 2020 requirements for case reporting based on information systems and indicated the At the onset of Covid-19, there was full essential role of information systems in the awareness at the national level regarding fight against the epidemic. the importance of data collection and information systems in containing the Later, on February 3, 2020, the NHC issued spread. The National Health Commission a Notice on Strengthening IT-Supported (NHC) and related departments actively Prevention and Control of Novel explored digital technology solutions to Coronavirus Pneumonia, which, for the tackle the accelerating outbreak. The first time, provided a comprehensive government further promoted and guidance centering around information provided strategic policy guidance on technology (IT) support for the disease prevention and epidemic control efforts. It fight against the Covid-19 epidemic. is clearly stated in this document that the supporting role of IT in enhancing areas On January 22, 2020, the NHC issued the such as epidemiology research,

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innovations in diagnosis and treatments, epidemic control should not be used for and service efficiency should be fully any other purposes. It provided exercised. Further, the Notice states that instructions on how to protect personal there should be applications to strengthen information of local residents such that data collection, and analysis and personal information can be safely applications, to vigorously promote collected and used. On the other hand, the telemedicine, to standardize Internet- CAC encourages companies to fully based diagnosis and treatment leverage big data, analyze and predict the flow of key population groups, such as confirmed and suspected cases, and strengthen foundation and security. As the contact tracing, providing additional first comprehensive national guideline on support in disease prevention and control. fighting epidemics with digital technology, this document explicitly provides On February 7, 2020, the NHC issued the guidance for the local governments, Notice on Performing Internet-Based Diagnosis and Treatment Consultation in applying digital technology in disease Services in Disease Prevention and prevention and control measures. It Epidemic Control, specifying the use of rapidly motivated the local governments digital technology in disease prevention to work with digital technology companies, and epidemic control across different while promoting the nationwide use of sectors. This Notice acknowledges the digital technology in the fight against the important role of teleconsultation, Covid-19 epidemic. including diagnosis and treatment, to provide timely health services to the A series of policy documents were soon public, while still emphasizing on its issued by the Cyberspace Administration supervision. The goal for this Notice is to of China (CAC) and the NHC with respect alleviate pressure for the overwhelmed to areas involved in standardizing and hospitals and medical personnel, advancing the applications of digital decreasing close contacts and reducing technology in disease prevention and risk of transmission. control in detail. Among those documents released, the Notice on Protecting It is now evident that at the onset of Personal Information and Utilizing Big Data outbreak, relevant government to Support Joint Prevention and Control, departments rapidly began to provide released on February 4, 2020, focused on guidelines and detailed measures the fundamental role of data regarding the ways to fight against the informatization in disease prevention and Covid-19 epidemic with the support from put forth further requirements on data digital technology. This reflects the usage and security. On one hand, the concept of advancing with times in the Notice states that personal information national level of disease prevention and collected for disease prevention and

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practice of digital enabled disease 2.1.3. Diversified development of tackling prevention and epidemic control. epidemic outbreaks with digital technology, February 14, 2020 to May 7, 2.1.2. Encouragements from President Xi 2020 Jinping, on February 14, 2020 Entering the second phase of the outbreak, On February 14, 2020, President Xi Jinping the epidemic control started to be more presided over the 12th Session of the comprehensively and multifaceted in its Central Committee of the Communist deployment, with a significant increase in Party of China (CPC) on Comprehensive digital applications. The Ministry Deepening of the Reform. He emphasized of Industry and Information Technology the need to improve the disease (MIIT) took the lead by issuing the Notice prevention and epidemic control system on Utilizing New-Generation Information and the national public health emergency Technologies to Support and Serve Disease management system. In his speech, Prevention and Epidemic Control and Work President Xi stressed the need to Resumption on February 19, 2020. The encourage the use of big data, artificial Notice responded positively to the intelligence, cloud computing and other instructions of President Xi on February 14, digital technologies to better support 2020, stressing the need to fully utilize epidemic surveillance and analysis, virus new-generation information technology to tracing, prevention, control and treatment, strengthen support for comprehensive and resource mobilization. This not only epidemic control, and specifying support affirms the achievements made in digital areas, such as disease prevention and applications in the early phases of the epidemic control, work resumption and epidemic, but also reflects the high service guarantees. This Notice further importance and support the country finds describes the guiding role in outlining the in the use of digital technology in disease subsequent digital technology empowered prevention and epidemic control. disease prevention and epidemic control. In the areas of data and communications, strengthened the confidence in the local the MIIT issued two important Notices, governments and departments to use focusing on network security and digital technology to empower disease promoting the accelerated development of prevention and epidemic control. The 5G during epidemic control, balancing speech received enthusiastic responses both short-term needs and long-term goals. from the local governments and every On February 18, 2020, the Notice on sector of society, significantly promoting Urging the Information and depth and breadth of digital technology Communication Industry to Effectively applications in prevention and control Guarantee the Network Security During the measures. Period of Disease Prevention and Epidemic Control promulgated and emphasized

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the importance of effective network enabled medical services at the national security support and employment policy level. A separate Notice was assurance for disease prevention and released by the NHC, focused on epidemic control. Aimed at the specific consultation, treatment, and post- scenario of outbreak prevention and discharge health management of Covid-19 control, the Notice set out two tasks for patients. This Notice called for steady and the information and communication solid establishment of a national industry. First, the network system teleconsultation platform center, security of key locations and users should incorporating case data platform and be guaranteed, specifically from technical video system, as well as the popularization support and monitoring and protection of relevant operating procedures. The aspects. The goal is to make command Notice highly stressed the importance of and control dispatch, and medical formulating and implementing a peopled- personnel support as convenient as centered health management program for possible. Second, information security discharged Covid-19 patients supported and network data protection need to be strengthened, safeguarding against technology. The Notice jointly released by Internet fraud and misinformation. Issued the NHC and the Comprehensive Group of on March 24, 2020, the Notice on the State Council on the Joint Prevention Promoting the Accelerated Development and Control Mechanism for Covid-19, in of 5G especially put forth the goal to which the informatization of medical deploy and promote innovative services were highlighted. The Notice provided concrete instructions on how to emphasis on the construction of the 5G alleviate stress for the medical services in smart medical system. The Notice calls for via online services such as further optimization and popularization of telemedicine, smart diagnosis, traditional 5G applications in the fight against Covid- Chinese medicine (TCM) diagnosis and 19, such as remote medical examinations, treatment, and mental health support. The teleconsultation, and medical assistance, Notice further requested medical to promote medical resource sharing. institutions to leverage information-based approach for triage and risk management, The medical services sector is the utmost such as staggered schedules and priority in the Covid-19 prevention and teleconsultation, and fully reinforced control. It is also the core connection applying information technology to between digitalization and the fight against the outbreak. From February 21, diagnosis and treatment capacity and 2020 to April 10, 2020, the ministries and capability. Furthermore, digitalization of commissions issued a series of six notices medical services also gave rise to new and speeches, encompassing all aspects policy implementation. On February 28, of medical services, fully demonstrated 2020, the National Healthcare Security the importance of digital technology

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Administration (NHSA) and the NHC jointly Construction and Applications for Covid-19 issued the Guidance on Promoting the Prevention and Control in Communities, issued on March 2, 2020, set out the Insurance Services During the Period of objectives and basic ideas of information- Covid-19 Prevention and Control, based construction and applications for requesting the social health insurance Covid-19 prevention and control in communities. The guideline stressed the healthcare operating services. The integration features must be applicable, Guideline proposed, for the first time, to convenient, safe, and with advanced -up services hindsight, it must also strongly support for common and chronic diseases in social data connectivity, and focus on population health insurance coverage, encouraging group management, information reporting, designated pharmaceutical institutions to and environmental improvements. Later, in innovate their delivery methods, such as the Guidelines on Precise and Refined providing contactless drug delivery Covid-19 Prevention and Control Efforts services. The following day, February 29, and Services in Communities, issued on 2020, Vice-Premier Sun Chunlan lead the April 14, 2020, information-based central steering group to Hubei and construction and applications for Covid-19 investigated the scientific researches that prevention and control in communities are had been made for disease prevention and further refined for communities at epidemic control. During this visit, Vice- different risk levels, with emphasis on the Premier Sun emphasized the following inspection and use of epidemic control tasks: establishing a green channel for health codes. scientific researches, intensifying screening and R&D of drugs with higher 2.1.4. Applications and improvements in clinical efficacy, give full play to the normalization of outbreak management, advantages of Traditional Chinese from May 7, 2020 to present Medicine (TCM), continuously improving As the epidemic situation normalized in diagnosis and treatment approach and China, the relevant governmental guidance, and defeating the epidemic departments specified the application of with science. digital technology in the planning of Lastly, information technology-based outbreak management, and summarized prevention and control in communities is the experience in fighting the epidemic a crucial link in community disease with digital technology to further improve prevention and epidemic control. It also and standardize the application of digital plays an important part in the diversified technology in long-term epidemic development of digital technology management. empowered fight against the epidemic. On May 7, 2020, the Comprehensive The Guidance on Information-Based Group of the State Council on the Joint

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Prevention and Control Mechanism for Covid-19 released the Guidance on 2.2 Effectively Implementing Normalized Prevention and Control of Covid-19. The The Impact of National Policies Guidance emphasizes that big data should play a role in normalized On February 28, 2020, the NHSA and the prevention and control. In particular, it NHC jointly issued the Guidance on highlights the need to comprehensively

the Period of Covid-19 Prevention and Control. The following were proposed in nucleic acid and serum antibody test the Guidance for the very first time: results, and information of key persons must be shared in a timely manner. Also, a  Internet-based hospitals that have been established under the approval of incoming persons should be introduced healthcare administration authorities, or to ensure the safety and the movement of medical institutions designated for population groups. healthcare security, whose Internet- based diagnosis and treatment activities Subsequently, the NHC released the have been approved by healthcare Notice on Standardizing Technical administration authorities, may Specifications and Financial Management follow-up services for common and of Public Medical Institutions and the chronic diseases. Notice on Further Improving the Medical Appointment System and Strengthening  These services will be covered by the the Construction of Smart Hospitals. The social health insurance. Notices instructed the hospitals to further follow-up services of designated non- public medical institutions may also be services, to establish and improve the covered partially, based on the pricing medical appointment system, to and payment policies for designated strengthen the construction of smart public medical institutions. hospitals, and to speed up the forming of Once the Guidance was issued, provinces the new medical service model featuring and municipalities responded rapidly, and online-offline integration. implemented real-name online registration and medical services system. They also supported the establishment of an online prescription audit system and a medical conduct regulation mechanism, all in an effort to actively promote local

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DIGITAL TECHNOLOGY RELEVANT POLICY (Continued)

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DIGITAL TECHNOLOGY RELEVANT POLICY

19 19 Using Digital Technologies

- Table 2.

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implementation of this new policy. The development of digital economy. As the implementation of the policy varied national pilot zones, the provinces began across different regions due to different to explore and promote the first social levels of digitalization, governance scope health insurance covered teleconsultation and objectives of the medical institutions. system and appointment and triage In some provinces, municipalities directly system. The implication is significant. First, under the central government and the scope of social insurance coverage autonomous regions namely , increased considerably, and was , , , , supported by large-scale informatization , , , , , of the social health insurance payment , , , , Inner system. Second, the policy of including Mongolia, , and the -up medical services - in social health insurance is a recognition up services into medical insurance was of Internet-based medical services, rolled out through trial implementation in indicating that they are valuable and are batches across the provinces (cities) worth being promoted nationally. The under the leading and unified planning of the provincial level Healthcare Security supported services, including Administration. In provinces and teleconsultation, remote diagnosis and autonomous regions such as , contactless drug purchase services , Hubei, Guizhou, , and throughout the epidemic have Tibet, this policy was implemented demonstrated the that Internet-based citywide, led by the municipal level medical services have their unique values Healthcare Security Administrations. In and great development potential. Beijing and , designated hospitals Moreover, by incorporating some services had the option to submit applications into medical insurance has strongly follow-up services into social health insurance. The policy of incorporating promoting the development of more -up medical services medical services to be digitalized and into social health insurance coverage conducted remotely, ultimately creating a profoundly enhanced the development of one-stop medical service that is not only social health insurance payment and practical, but convenient and efficient. Internet-based medical services. Since the integration, Province ( New Area), Zhejiang Province, Fujian Province, Guangdong Province, Chongqing, and Sichuan Province became the designated national pilot zones for innovative

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 23 FAST RESPONSE Fast Response

As the natural leader for overall outbreak prevention and control, governments from all levels need to make coordinated and concerted decisions, and deploy measures within a short period of time at the onset of an epidemic. To achieve fast response, timely and reliable data, and information, support is critical. Therefore, rapid information platform construction, and data collection and monitoring are essential for the government to implement effective strategies to increase epidemic preparedness and mitigate the impact of the outbreak.

3.1 Digital Technology in Fast health information, clinical data, and Response epidemiological data, realizing individual information tracking, clinical early warning decision making, and efficient resource 3.1.1 Assist the government in collecting allocation management. The platform and analyzing epidemic data to support provided the core support for scientific decision-making policy decision-making on Covid-19 In the early stage of the epidemic, the outbreak measures in County. government needed to grasp key relevant 3.1.2 Assist the government in information such as clinical data, disease identifying and tracking high-risk groups control data, and public reactions, to to implement prevention and control coordinate the prevention and control measures with precision measures scientifically. Driven by these needs, an integrated data platform was Covid-19 is highly contagious, and thus the developed. The platform is able to identification and tracking of high-risk aggregate, manage, cleanse, store and groups are especially important for analyze multiple sources of data into governments to implement precise various comprehensive reports. The prevention and control measures. aggregated data empowers the government to make informed With the consent for information assessment and calculated decisions, authorization, many companies utilized such as local medical resources allocation, artificial intelligence and big data analysis predictions on the future trends of the to promptly provide the local government epidemic, allowing an effective and with population tracking analysis of both efficient response. permanent and mobile population, based on geographic information systems and For instance, Digital China Health built an location-based services. The companies integrated data platform for Honghu helped the local government to quickly County government in Hubei Province. initiate different levels of management strategies based on the actual situation, in

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a timely and appropriate manner. At the DC Health has in-depth focus across four same time, through establishing a areas, healthcare big data, medical cloud monitoring platform, key locations such as services, healthcare informatization and hospitals, shopping malls, schools, railway precision medicine. It offers stations, and airports helped provide real- comprehensive and integrated time alerts to the public. Warnings such as informatization solutions such as the wearing of masks, population flow, Healthcare Big Data platform and Hospital and abnormal body temperature are all IT Integration. DC Health has a global conducive to providing real-time outbreak leading team specialized in a variety of status. fields in Healthcare Big Data, ranging from data structuring, data standardization, - quality control, security and privacy owned Internet service operators, namely protection, multi-data fusion analysis, and China Telecom, China Unicom, and China real-world evidence (RWE) research. With Mobile, along with Mininglamp these expertise, DC Health provides Technology, and Inspur Group, all services to the government, hospitals, established monitoring and tracking research institutions, pharmaceutical platforms for local governments to companies, and medical technology achieve precise outbreak prevention companies. DC Health is dedicated to status and control measures from macro utilize its in-depth expertise and solutions level to micro level, offering real-time to empower and further enable public monitoring and population flow data. health management, smart clinical decision, hospital operational 3.2 management, clinical research, RWE, and drug development. Case Study I: Digital China [1] BACKGROUND: Integrated Data Health System Facilitated Timely Government Decision-making and Epidemic Analysis ABOUT Digital China Health Integrated data system integrates clinical Digital China Health (DC Health) is an case data from the medical system, innovative healthcare IT and Big Data epidemiological data from the public company. DC Health is committed to health surveillance system, and all other develop an independent technology general epidemic data, into one system, with the goal to not only standardized framework. The integrated continuously enhance the overall level of data system then conducts a series of data analysis. During the Covid-19 also to drive the reform and innovation in outbreak, infected cases rose rapidly, the development of healthcare big data, putting tremendous pressure on medical globally. and disease control departments across

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all levels of governments in China. As the central region of Hubei Province, and is lead commander of epidemic prevention under the jurisdiction of City. and control, the government had to Honghu County has a population of quickly obtain a multitude of data related around 950,000 and is only 120 kilometers to Covid-19 in order to formulate a away from Wuhan. According to estimates, comprehensive prevention and control around 49,000 people returned from strategy. Medical personnel were also in Wuhan to Honghu County just before the urgent need of updated information and Chinese New Year holiday, returning home data on Covid-19, especially clinical data with many imported Covid-19 cases. In fact, from case treatments and patient as of February 12, 2020, before the management, to effectively triage patients and carry out appropriate the cumulative confirmed cases in Honghu treatments. Further, public health County had already reached 262, with information with timely dissemination and severe and critically ill patients accounting announcements are crucial in times of pandemic crises. Providing updated confirmed cases, making Honghu information for the general public can effectively help mitigate widespread Jingzhou City. Honghu County faced two panic and fear. Therefore, under such main challenges at the early stages of circumstances, building an integrated Covid-19 outbreak: data system is extremely critical in the early onset of an epidemic for timely [2.1] The lack of Covid-19 data government decision-making and integration epidemic analysis. The system and its Data aggregation was slow at the analytic methodologies can also become beginning of the outbreak since there was a reference for other countries and no integrated data System available. The regions who are undergoing the same Novel Coronavirus Prevention and Control epidemic crisis. Command Center of Honghu County faced [2] CHALLENGE: Regional Prevention shortage in collecting Covid-19 related and Control Efforts Lacked a Timely and information from residents, suspected Integrated Data System patients and confirmed patients, and was thus unable to make informed policy The Covid-19 outbreak in China coincided decisions and delegate specific tasks to with the Chinese New Year, the period other agencies. Therefore, it was critical with the largest human migration, for the Command Center to gain access to annually. Originating from Wuhan City, the timely information on Covid-19. Based on virus quickly spread to nearby cities. the integrated and updated information, the Command Center can further allocate One in particular is Honghu County. responsibilities for each government Honghu County is located in the southern department and ensure that the prevention

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and control strategies were both efficient Upon receiving the task appointed by the and effective. local government, DC Health promptly gathered a team of forty experts. The team [2.2] Data collected is unable to indicate consisted of 30 engineers, responsible for and predict Covid-19 developments in a building the data system, and 10 data timely manner analysts, responsible for producing the As neither aligned data collection formats analysis reports. Together, the team must nor reporting mechanisms were provide timely reports to the government established across different medical based on its requests, with an average institutions, and between medical turnaround time of around two hours. institutions and local Center for Disease However, due to travel restrictions during Control (CDC), it was difficult to match Covid-19 outbreak, the DC Health team data from different population segments, had to stay in their Beijing office, such as healthy population, high-risk supporting the project remotely. To ensure population, and suspected cases. This data security, DC Health hired an made it difficult to trace data and produce independent data security auditor to analytics that were vital to government decisions. Mengchun, the Vice President of DC Health, was physically in Honghu County to oversee the entire project, and to be in Data System close communications with Honghu County government. Four experts from Given the aforementioned challenges, Nanfang Hospital also provided technical described in the previous section, DC support for the construction and Health built an integrated data system that operations of the integrated data system, enabled Honghu County government to with three working remotely and one on- be fully informed and properly respond to site. a variety of complex issues during Covid- 19 outbreak. As the project lead, the Honghu County government was in control of the [3.1] Working with the Guangdong integrated data system. The Mayor of medical team to support Honghu Honghu County directly coordinated the County resources required to build and operate the data system. Honghu County Health On February 12, 2020, the Guangdong Bureau aligned the data systems across Medical Team entered Honghu County. As the different hospitals, while Honghu part of the Medical Team, DC Health was County Big Data Bureau oversaw data in charge of building an integrated Covid- collection, such as improving the rate of 19 data system. On February 14, 2020, information reporting, conducting on-site within 72 hours, the DC Health team built verification, and resolving data related the system. issues when they arise.

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[3.2] The Three platforms that forms of Honghu County to access the survey. Honghu Second, in order to gather a wide and system detailed range of personal health information, the survey had to be [3.2.1] The resident health data WeChat published by a credible agency. Honghu reporting platform County Publicity Department has set up an Honghu DC Health established a WeChat-based resident health data platform, using a The account became an influential and public WeChat account as an information trustworthy source of information for the collection portal for the local residents. local residents, with regular news updates This platform was designed to survey and and Covid-19 information. Under the support of the local government, DC across different population groups. The Health built a health status input portal monitoring targets include the general Honghu population, inpatients and discharged logged into the public account, they could patients, high-risk groups (i.e. people with easily enter their personal health Wuhan travel history, people with contact information. Another reason for selecting history of diagnosed patients, or medical WeChat is its backend system. WeChat observers who received patients at provided DC Health with reliable resources, quarantine locations), medical personnel allowing DC Health team to access a (such as doctors, nurses, public health relatively more open-ended backend experts and social workers). The data system and a wide range of functions. The collection survey was designed by pre-existing collaboration between DC infectious disease experts at Nanfang Health and WeChat has laid a solid Hospital and revised jointly by local foundation for this platform. government officials, local clinicians, public health officials, and information Initially, when Honghu County launched technology experts. On March 2, 2020, as the epidemic situation gradually stabilized response rate was only around 25%. and the government began to encourage However, as the local government began back to work, the data collection survey to strengthen its administrative efforts, was then adjusted to include content on monitoring daily response rate, assessing job search support. the community performances, and urging for improvements through community There were several reasons DC Health administrators, the daily response rate selected WeChat as its data collection successfully rose to over 95% within a very platform. First, WeChat has a high market short time. penetration rate within China, allowing residents from both urban and rural area

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[3.2.2] The clinical data platform clinical data. In addition, DC Health had taken necessary measures for data security The clinical data platform collects, and maintenance. processes, and analyses clinical data from electronic medical records (EMR) from [3.2.3] The epidemiological data nine hospitals, and thus became a clinical platform database covering various platforms and hospitals. The platform also encompasses The epidemiological data platform a critical illness decision-support function. integrates data from three locations: 1) a Based on a mortality risk prediction model third-party polymerase chain reaction -19 data, the laboratory, 2) a third-party antibody Platform is able to generate mortality risk research laboratory, and 3) the CDC. figures for confirmed Covid-19 inpatients [3.2.3] The epidemiological data on a daily basis. This allows hospitals to platform take corresponding clinical management The epidemiological data platform Introducing the mortality risk prediction integrates data from three locations: 1) a system improved the quality and third-party polymerase chain reaction effectiveness of clinical and patient laboratory, 2) a third-party antibody management, thereby lowering mortality research laboratory, and 3) the CDC. rate across the hospitals. This attempt in Because the calculation of daily case Honghu figures from CDC is a closed-door process, application in using the mortality risk the DC Health platform simply extracted prediction system on Covid-19 patients. and combined those case numbers with The fact that not all the nine hospitals testing results from, the two laboratories, were equipped with the Hospital rather than merging its platform directly Information System (HIS) made it difficult for the data to be transferred outside of the hospital. Urged by the local government, the hospitals with-out HIS prioritized the deep integration of quickly installed HIS during the initial epidemiological data and clinical data. It outbreak, and completed the data inputs. does so by extracting raw data and With the support of local government, DC integrating them into the system using DC Health was also able to bypass -automatic technology. The complicated processes and directly integrated data system also continues to extract raw clinical data from hospitals monitor a plethora of information through and integrate them into its platform. Through the processes of data aligning, status, suspected morbidity, diagnosed, structuring, and analysis, DC Health was referrals, mild symptoms treatment, able to provide relevant epidemic and critically-ill treatment, death or recovery

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from discharge, mental health, to the came from various different platforms, resumption of labor. By analyzing data institutions, regions, and sources. For from each stage of the outbreak, DC instance, there were data from patients, Health was able to produce figures on hospitals, and public health officials, yet in Covid-19 trends and compare between various formats. Without cloud technology, towns and villages. These results informed these various forms of data could not be policy making, supported clinical properly integrated nor translated. In decisions, mobilized medical resource addition, data integration is time distributions, and ultimately met various consuming, the hardware used would needs requested by the local government need to have the flexibility for expansion throughout the outbreak. and hardware upgrades; 2) With the travel restrictions and quarantine policies in [3.3] Cloud services ensured the place, it was not practical nor feasible to successful construction of Honghu purchase and install physical hardware across Hubei Province; 3) Given the physical constraints during the outbreak, it In terms of hardware selection, DC Health was also difficult to assemble a technical decided to use cloud services for the team to be based locally. The cloud technology allowed experts across the

Figure 2.

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country to work and collaborate remotely. and tested. These response rate suggests As a result, the cloud technology became that it is possible to conduct population tracing on a centralized platform. Monitoring the fluctuation of daily In terms of the process of building a cloud reported cases and tracing confirmed service platform, Honghu County government purchased cloud service from these data provided the local government a mobile operator. Honghu County Big tremendous evidence and confidence in Data Bureau oversaw the security its decision making. management of the operator. Once the [4] DISCUSSION along with the technical team of the cloud service provider, spent between three to five hours on the initial set up of the During the Covid- team, along with the Guangdong Medical days to refine the cloud system until it Team, worked under tight time constraints reached stable operation. Once the cloud and tremendous pressure. The team, service was able to operate stably, DC however, was able to quickly respond to tackle the challenges. The following passkey back to the government. In the process of this transfer, DC Health also success in establishing an integrated provided training for the government healthcare data system in Honghu County. officials in personal data protection and relevant safety measures. In other words, [4.1.1] Strong government support in Honghu County government has complete policy implementation and resources control over the hardware behind the database, thereby eliminating the Honghu County government provided tremendous support to the DC Health team and took a leading role in the entire Under the joint effort of DC Health and project in a concerted attempt to control various stakeholders, Honghu and contain the virus. In the early stages resident health data platform eventually of the project, for instance, the local reached 97% response rate (among government quickly deployed local current residents) and received over technicians to support the DC Health team, 700,000 responses on a daily basis. As of purchased the cloud service, and March 16, 2020, the cumulative health supported DC Health during the status self-reporting reached 17.5 million. development and design of the system. Through door-to-door visits or phone calls, Once the system began to operate, social workers were able to track over different agencies within local government 10,000 positive Covid-19 cases, of which worked together to collect and compile 30 cases were asked to be quarantined data. The local health bureau, for instance,

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coordinated the extraction of data from inconsistent, the quality of data varied hospital HIS and assisted hospitals drastically from hospital to hospital, and without HIS to install the system. The Big database at CDC was inaccessible. As Data Bureau, on the other hand, helped these problems were difficult to solve solve problems that each community within a short time span, DC Health faced, and encouraged communities to decided to extract raw data directly from voluntarily report health status the HIS system in each hospital. The team information. DC Health and Honghu then manually keyed in and analyzed those County government worked in tandem. data. While the temporary strategy was able to effectively solved technical was able to quickly complete the project, challenges with data extraction, it was and the project in turn informed the incredibly labor intensive.

[4.1.2] Expert input and on-the-ground security and compliance personnel sped up the database construction process At the early stages of building the data system, Honghu County government was In working with the Guangdong Medical very concerned about data security and Team, DC Health received tremendous privacy. To dispel worries from the support from experts at the Nanfang Hospital, where most of the Guangdong communicated with government officials Medical Team members were drawn from. and designed a series of data protection Specifically, Nanfang Hospital deployed protocols with the local government. It was ensured that the government President, Dr. Gong Mengchun, who was ultimately had ownership and control over stationed in Honghu County. Dr. Gong the data system by DC Health returning express-ed in his interview that the four the password back to the government experts from Nanfang Hospital, who after completing cloud service helped coordinate and communicate with construction. In addition, Nanfang Hospital other stakeholders on the ground, were was responsible to conduct ethical indispensable to building the data system evaluations of the project, and its high within just 72 hours. reputation helped ease government concerns over data security. solve the blockage of hospital data Data security during the operation of cloud circulation service was also a key concern, and the quantification of the reidentification risk In the process of collecting clinical data after data desensitization is an important from hospitals, DC Health faced several reference index for the protocols. problems: the data formats were often

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Fortunately, DC Health is specialized in during data collection. This was one of the desensitizing medical data. Within key reasons DC Health was able to quickly conventional network security regulations, act and build the data system. DC Health also ensured that it conducted through auditing and employed data [4.2] Necessary conditions to replicate desensitization technology in the process of operating the integrated data system.

DC Health also trained all employees who in Honghu County are outlined above. The would come into contact with the data following few passages describes system. Due to the urgency of the situation, necessary conditions for similar projects to launch in other countries or regions: raw data, manually key in those data based [4.2.1] A social media network or data on a pre-determined data structure and platform with high market penetration platform. Therefore, prior to the launch of WeChat is a social media tool with existing the project, DC Health team used an entire high market penetration and user volume afternoon to conduct a data security in China. It is also extremely user friendly, training for all the employees, each of which enabled DC Health to closely whom then signed an agreement which monitor citizen health status and to reach laid out basic protocols, clear boundaries near 100% response rate. Other countries of data security, and corresponding trying to execute similar projects should penalties for breaching the agreement. In consider whether such a platform exists addition to the training, an independent within the community. If not, they could data security auditor was stationed locally consider building a platform for targeted to monitored daily operations, correcting population segments during such wrong practices and reporting to the pandemic outbreak or crisis situation. management team on a daily basis. [4.2.2] Hospitals need to be equipped [4.1.5] Donations simplified purchasing with HIS system process Although DC Health had to manually There are operational problems such as collect data during the outbreak in compliance and procurement process in Honghu County, it was important for retrieving data from various systems. The hospitals to have HIS systems in place for fact that the whole cost of this assistance data collection to even be possible in a was borne by DC Health itself categorized very short period of time. Medical the assistance as a donation, which personnel in hospitals should also be directly simplified the bidding, equipped with updated HIS system-related procurement and compliance processes knowledge in order to ensure that raw data across hospitals can be standardized.

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[4.2.3] Government coordination tracking methods. This upgrade to advanced information platforms can improve the efficiency of data analysis, to coordinate actions across sectors is the and can provide more reliable information most important condition. In Honghu support to the government for decision- County, the establishment of the big data making. bureau laid a solid foundation for DC government to centrally manage the 3.4 situation during a public health crisis while assigning tasks beyond pre- Limitations and Challenges designated roles. Other governments can consider doing the same through 3.4.1 Fragmented and disconnected establishing a central command center systems, resulting in ineffective flow of during a pandemic outbreak or similar data level of crisis. Currently, the medical system and the public health system are not integrated 3.3 with each other, thus the respective clinical data and the public health Value of Digital Technology in information collected cannot be promptly Fast Response integrated and analyzed. There are inconsistencies in the format and 3.3.1 To the government reporting mechanism of data between medical institutions and Centers for Digital technology helps improve the Disease Control (CDCs), as well as between different medical institutions. decision-making in response to the public Clinical institutes also require a better health emergencies. Governments need to mechanism in uploading and sharing their make specific decisions and implement data. Furthermore, with poorly integrated effective measures within a very short data from multiple channels, it is very period of time when facing various difficult to effectively compare and match. adverse circumstances, uncertainties, and In the face of emergencies that require other factors during public health fast response, these issues create emergencies. The information platform, magnified difficulties in data analysis and using advanced technologies including tracing, making it even more difficult for artificial intelligence, data middle platform, digital technology to engage seamlessly big data analysis, geographic information and provide a rapid and panoptic view of system, and location technology, is an the outbreak. upgrade from traditional manual data collection, analysis, monitoring, and

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3.4.2 Strict information security thresholds set requirements on private sector participation

As information collected encompassed personal data such as location information, companies need to take strict and comprehensive safeguards on information security. This greatly increased the threshold for companies to participate in fight against Covid-19, most of the companies that participated in the fast response are state-owned. Each company has its own strategy for information security, and thus it is difficult to achieve uniformity in information protection. How to allow more companies to participate in fast response to emergencies with unified information protection mechanism must still be further explored.

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 36 EPIDEMIOLOGICAL STUDIES Epidemiological Study

Understanding the characteristics of a virus is essential for infection prevention and epidemic control. SARS-CoV-2, the virus that causes Covid-19, is a novel virus that requires comprehensive and in-depth investigations and research, such as testing, diagnosis, treatment, virus tracing, mutation prediction, as well as their mode and scale of transmission. Therefore, it is of great significance to carry out epidemiological studies on SARS-CoV-2 as soon as possible for better outbreak prevention and control.

4.1 Digital Technology in For instance, MGI Tech (MGI) Epidemiological Study provided the first batch of high throughput sequencer to assist professionals and researchers around the 4.1.1 SARS-CoV-2 genetic sequencing world to conduct genetic sequencing and and protein structural research assembly of the SARS-CoV-2 at a faster pace. It also provided the basis for the Genetic sequencing and protein structure rapid development of subsequent research of the SARS-CoV-2 are the first fluorescent PCR kits. steps in understanding this novel virus. Using artificial intelligence and 4.1.2 Projections of the scale and supercomputing capabilities can codify prevalence of the outbreak these two complexed research areas and convert a biological enquiry into a It is believed that the Covid-19 outbreak in mathematical one that can be rapidly China originated at a seafood wholesale analyzed and computed in terabytes and market near a transportation hub in Wuhan. even petabytes worth of stored data. On The outbreak coincided with the Chinese one hand, the highly efficient computing New Year, also the largest human power significantly reduces the time migration annually, bringing significant needed for the genetic sequencing of challenges to the epidemiological study. SARS-CoV-2 retrospectively by comparing The study of epidemiological history is, in the sequencing results with other viruses. turn, directly related to the prediction of On the other hand, computing models the scale of transmission and offer direct visualization of the SARS-CoV- epidemiological trends of the virus. In 2 protein structure, and thus help us epidemiological history tracing, extensive understand its pathogenesis and analysis of data from transportation, transmission mechanisms. At the same payments, and travel can play an time, the use of big data computing can important role in the development and predict the mutation of viral proteins and analysis of infection models. At the same can grasp the possible future mutation time, based on epidemiological history trends of the virus. research models, the use of big data and artificial analysis can further make more

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accurate predictions and simulations of screening from literatures and laboratory the existing scale of transmission and data, simulates the ligand-receptor future epidemic trends, unleashing the binding effects, and provides data analysis potential value of the data. in a stable and efficient data computing support for research and development. For instance, with its enhanced SEIR model and AI capabilities, For instance, technology companies such Innovative Data Technologies set up as Sugon, Sense Time and Tencent, in Covid-19 outbreak simulations and collaboration with the National prediction models and helped Prof. Zhong Supercomputing Center in Shenzhen, Nanshan consolidated the research results released a platform for research and on the progress of the outbreak, and development of drugs and vaccines for subsequently served as an important SARS-CoV-2. Relying on the super- reference for national level epidemic computing power, the platform supported prevention and control strategy. researchers to conduct full-scale research and screening of therapeutic agents. 4.1.3 Drugs and vaccine development Baidu and the China Center for Disease for SARS-CoV-2 CDC Emergency Technology Center - To strengthen the control of the Covid-19 outbreak, it is important to invest into accelerate the genetic analysis and research and development of drugs and vaccine research for SARS-CoV-2. vaccines for the highly transmissible virus. In addition, extensive data analysis and literature reviews are necessary to support the research and development of new drugs and vaccines. Whether it is screening molecular databases to find Note potential candidates for treating SARS- CoV-2, or formulating new medications In this report, the research team focused based on its genetic information, the on three aspects of the epidemiological massive amount of data and myriad of study, namely gene sequencing and possibilities under the complex viral protein structure research, predictions on structures are important factors hindering the spread of outbreak and the efficiency of research and epidemiological trends, and research and development. Therefore, the combination development of drugs and vaccines for of big data, AI and computing power has SARS-CoV-2. vital importance in the research and development of medication and vaccine No specific case was selected in this part for SARS-CoV-2. The application of these for the in-depth study. The two main technologies allows rapid molecular reasons are:

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1) The participation of companies in and policies to mitigate the foreseeable epidemiological study remained risks in the future, and to minimize the relatively simple, with a focus on potential devastation caused by the providing technology support directly outbreak. to relevant research institutions, such as supercomputing, artificial 4.2.2 To the healthcare system intelligence, and big data analytics. For the healthcare system, the use of These cases shared many similarities; digital technology in epidemiological 2) The difficulties and challenges in the study has improved the capacity of use of the technology are mostly diagnosis and treatment. On one hand, the problems of the technology itself, rapid sequencing of virus and the such as optimization and optimization of sequencing capabilities enhancement of algorithms, models, can improve the efficiency and quality of and computation power, which are virus detection in health care and disease beyond the scope of this case study control. On the other hand, the use of report. digital technology in viral proteins can provide a structural understanding of the viral pathogens, and screen for potentially 4.2 effective drugs from already developed drugs. This allowed medical institutions to Value of Digital technology in experiment with different targeted Epidemiological Study treatments using tools available, thus optimizing treatment plans and improving 4.2.1 To the government outcomes. Ultimately increasing efficacy and efficiency in the healthcare system. The use of digital technology in epidemiological study has accelerated the 4.2.3 To the industry understanding of viruses, and in this case, Pharmaceutical companies have been SARS-CoV-2. It has allowed more timely using digital technology for drug research interventions and regulations from the and development for many years. Due to government to control the viral the nature of the Covid-19 outbreak, the transmission and to manage the spread, value of digital technology in drugs and delineating the relationship between vaccines development and research for SARS-CoV-2 and other viruses. This has SARS-CoV-2 is amplified. The rapid helped develop more specific prevention screening of literature and experimental and control strategies and policies. In data to identify potential viral targets and addition, through more accurate chemical compounds has set directions predictions on the virus mutation, trends, for developing specialty drugs and and scale of transmission, the government vaccines. The use of digital technology can proactively prepare strategic plans has significantly accelerated the drugs

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and vaccines research and development computing power has become an processes, enabling pharmaceutical important and widely used research companies to complete the development resource. Many technology companies process in the shortest possible time and had proactively provided technology and at a lower cost. technical support in sharing computing capabilities with relevant research institutes to empower the research of 4.3 SARS-CoV-2. Under such circumstances, Limitations and Challenges government and relevant departments should better mobilize and distribute the existing available computing resources 4.3.1 Predictive models have more according to the computational difficulties academic research significance than and level of urgency, in order to enhance their practical value the utilization of the computing resources. In the future, computing resources will As computer models use available data become increasingly important. Therefore, and algorithms to make predictions of viral government should establish a more mutations and epidemic trends, they can holistic computing resource coordination only produce the most likely similar results system in preparation for future public based on model calculations and are not health emergencies. representative of actual developments. In reality, human interventions and non- 4.3.3 Nominal business value human contingencies can lead to many variables that make it more difficult for Aside from drugs and vaccine research predictive models to accurately reflect and development, other dimensions of future epidemic progression. Although epidemiological study do not have a references can be made from these mature business model and commercial predictive models in policy making, actual value. Technology, such as big data, policy decisions require comprehensive artificial intelligence and supercomputing, consideration of social, environmental, require large investments. Yet, these do and economic factors. Therefore, such not guarantee to generate revenue, predictive models carry more academic especially during a pandemic outbreak. It research value than actual practical is also difficult to rely solely on technology bearings. companies to fully devote support on epidemiological study in the long run. 4.3.2 Computing power resources Therefore, the government and other require further optimization social enterprises should recognize the value and necessity of the technological During the outbreak, in order to improve efficiency of epidemiological study, and should provide appropriate support.

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 41 Epidemiological Study

By promoting and fostering a mutually beneficial relationship between technology companies and research institutes, the quality and efficiency in epidemiological study can be sustained.

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 42 DIAGNOSIS & TREATMENT Diagnosis and Treatment

Diagnosis and treatment involve the contact between medical personnel and patients, which is an important part of outbreak prevention and control. In order to improve the utilization efficiency of medical resources, avoid cross-infection, and meet the needs of medical services, the application of data networks, the Internet, artificial intelligence, 5G, and other technologies in this field is worth studying.

5.1 Digital Technology in Diagnosis For instance, United Imaging provided digital imaging equipment to Wuhan and Treatment modular hospitals in the early stage of the outbreak to help realize the remote 5.1.1 Set up remote diagnosis and diagnosis and scans, and thus reduce the treatment risk of disease transmission between doctors and patients. Taking the During the Covid-19 outbreak, a large advantages of 5G for being high- number of patients emerged in high-risk bandwidth and low-latency, China Telecom areas, but the number of medical and other Internet service operators built a institutions and doctors could not meet Covid-19 Teleconsultation Platform with the rapidly growing demand for medical tertiary hospitals as the core, radiating to services. Furthermore, during the other medical institutions around the examination process, close contact was region. WeDoctor, an Internet hospital, extremely likely to cause cross-infection. In provided patients with Covid-19 diagnosis other areas, the medical resources for non- and treatment services through online communicable diseases have been consultations, under-took the medical squeezed. Meanwhile, to avoid cross- needs of patients with common chronic infection, medical institutions set diseases, and established a psychological limitations on the number and manner of assistance section to provide free face-to-face diagnosis and treatment, psychological consultation and which makes it difficult to meet public professional counseling services. needs on medical services. Advanced technologies such as data networks, the 5.1.2 Assist the management of home Internet, artificial intelligence, and 5G care helped gather doctor resources across the The guidelines issued by the World Health country. Through online consultation, Organization indicated that when remote diagnosis, and intelligent hospitalization conditions were not identification, the diagnosis and treatment allowed or unsafe, and medical resources capabilities and efficiency of frontline were insufficient, home quarantine should medical institutions were improved, be considered for suspected patients with contributing to meeting various medical mild symptoms. The Internet and artificial needs of the public.

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 44 Diagnosis and Treatment

intelligence connected multiple health [1] BACKGROUND: Imaging Diagnosis service providers such as knowledge Served a Crucial Role in The publishers, Internet hospitals, and offline Management of Covid-19 tertiary hospitals to provide patients with convenient, scientific, and comprehensive Bounded by the limitations of Covid-19 home care knowledge and supporting nucleic acid tests, including the services. insufficient supplies and limited number of laboratories, as well as false positives For instance, MedLinker, Zuo Shou Yi caused by inappropriate handling of the Sheng, and other intelligent medical nucleic acid test kits and varied qualities platforms launched service programs for of test kits, many suspected Covid-19 home quarantine, including intelligent patients failed to receive timely and screening and pre-diagnosis, intelligent accurate diagnosis. check-in, and medicine delivery. In addition, the intelligent medical platform As Covid-19 is an acute respiratory also provided knowledge to the public. infectious disease, thoracic imaging played a crucial role in the diagnosis of suspected cases and the disease 5.2 progression monitoring in severe cases. The National Health Commission (NHC) Case Study II: United Imaging has highlighted the importance of thoracic imaging in the diagnosis of Covid-19 in the Diagnosis and Treatment Protocol for ABOUT United Imaging Novel Coronavirus Pneumonia (Fifth United Imaging Healthcare Co., Ltd. Edition). The protocol stressed that (United Imaging) is a professional thoracic imaging would be the standard advanced medical imaging company diagnostic tool for Covid-19, rather than covering imaging diagnosis and treatment relying on nucleic acid test results only. and offers innovative medi-cal information In the Diagnosis and Treatment Protocol technology solutions. United Imaging is an for Severe and Critical Cases of Novel exceptional company that develops and Coronavirus Pneumonia (Second Edition), produces a full portfolio of advanced the NHC also emphasized that thoracic medical imaging and radiotherapy imaging allowed early identification of equipment. Its portfolio encompasses severe Covid-19 cases. CT became a several advanced imaging specialties, commonly used imaging method and was including modular imaging (MI), positron widely used in the diagnosis and disease emission magnetic resonance (PET/MR), monitoring of Covid-19 patients. A computer tomography (CT), magnetic research study led by Prof. Zhong Nanshan, resonance imaging (MRI), X-Ray, a prominent epidemiologist and radiotherapy (RT), medical software (HSW). pulmonologist and lead medical advisor

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 45 Diagnosis and Treatment

for China during Covid-19, had a sample 13,400 hospital beds were available for size of 2866 cases of Covid-19 patients. admission of 12,000 mild Covid-19 cases. Among the 2866 Covid-19 cases, 2528 Because of its temporality and short (88.2%) detected abnormalities from CT construction period (the shortest duration scans, including bilateral or unilateral to construct a modular hospital took only ground-glass appearance and opacities. 20 hours), modular hospitals were not Majority of the cases with pulmonary designed to equip with high quality abnormalities detected by CT scans was hardware facilities and professional clinical subsequently confirmed as Covid-19 cases. teams, comparing to regular hospitals. However, as CT scan was proven and [2] CHALLENGES: Rapidly Increasing CT assigned to be a critical method to support Scan Demands During the Outbreak clinical diagnosis and managements of Covid-19 cases, there was an urgent need The role of CT scans to detect Covid-19 is for rapid establishment of radiological irreplaceable. However, it is demanding in departments in the modular hospitals. terms of technology and professional personnel. As Covid-19 cases rose [2.2] Risk of transmission during CT exponentially across the country, so did scans the demand for the CT scans. The capacity across the country during this period was In standard CT scan sessions, medical unable to meet the needs. The challenge professionals need to be in the same room manifested in three facets: as the patients in order to aid the positioning of the patient to ensure [2.1] Lack of CT scan capacities in adequate and acceptable imaging quality. modular hospitals The space in the CT scan rooms are restricted and enclosed, forcing the patient During the critical period of the Covid-19 and the medical professionals to be in outbreak in China, in response to the close contact with each other. With Covid- 19 highly human to human transmittable, all where and when possible to avoid this greatly increased the risk of spread. Despite the efforts in many hospitals to modular hospitals were constructed. The minimize the risk of transmission by modular hospitals not only alleviated the implementing infection control protocols shortage of medical resources, especially in radiological departments, transmission in Wuhan City, but also provided a refuge was inevitable. for the mild Covid-19 cases who were unable to seek treatment in other hospitals. [2.3] Limited radiologist capacities to 16 modular hospitals were built in Wuhan interpret CT images City. 15 were used since the first modular hospital began operations on February 5, Shortage in radiologists has been a 2020. On March 10, 2020 the last modular persistent issue in China. Studies showed hospital was finally put to rest. A total of that the radiological demand increased at

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 46 Diagnosis and Treatment

an annual rate of 30%, while the annual [3.1] Emergency radiology department in growth rate of the number of radiologists modular hospitals was only at 4.1%. In addition to the number of radiologists, the levels of their United Imaging designed a fast, agile, expertise also varied, which further mobile and smart radiology solution called affected the efficiency and accuracy of diagnosis. Reading the images and reports are time consuming as well. as Emergency Radiology Department Statistically, a senior radiologist spends on (ERD). The ERD piloted at the Wuhan City average 7 to 8 minutes to read a CT report. Jianghan Modular Hospital. It In other words, it would take over 12 hours accomplished close to two hundred CT to read a total of 100 reports. At the peak scans for Covid-19 patients on the first day of the outbreak in Wuhan City, these of its operation. The ERD comprised of a aforementioned limitations exacerbated set of essential technologies including the existing challenges for the epicenter. individual CT suits, operation rooms, and As a result, it was vital to explore means to ultraviolet disinfection devices. better mobilize the limited resources, and Architecturally, the ERD is a box-like to better utilize artificial intelligence to structure independent from the modular improve the efficacy and accuracy of and regular hospitals. It is designed to be radiological diagnosis of Covid-19 cases. easily assembled and transported, occupying a small area of merely 20 [3] SOLUTION: The Remote Diagnostics square meters and requires only electricity Platform by United Imaging to operate. Furthermore, it is waterproof, heat-isolated, and isothermal, which In order to tackle the three challenges allows smooth operation even under described earlier, United Imaging offered extreme weather conditions. The ERD was a software-enabled, end-to-end remote designed to be a great frontline solution in diagnostics solution to improve the CT times of crises. image diagnosis processes. This solution examination in three aspects: the design considerations when designing the ERD and construction of a modular CT was radiation isolation and on-site assembly. United Imaging team needed to the modular hospitals, remote Covid-19 make sure the CT scanner chosen is diagnosis platform, and artificial compact, easy to transport and assemble, intelligence-enabled image diagnostic as opposed to the high-end CT scanners systems. The holistic end-to-end solution that are usually large and immobile. The leveraged medical big data, cloud team collaborated closely with Wuhan platforms, artificial intelligence, and 5Gnetworks to provide high quality and designers to continuously refine the ERD. fast imaging diagnosis for patients. Together, they effectively shortened the assembly duration, from 3 days to 24

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 47 Diagnosis and Treatment

hours. By the end of March, United technologies to build medical data transfer Imaging provided Wuhan City government systems for the modular hospitals. with 61 CT scanners and 27 mobile DR Leveraging the power and the efficiency of devices during the outbreak, and 5G technologies, the speed of data drastically advanced the imaging transfer was four times faster than the diagnosis capacities in the city. traditional networks, while still ensuring data security and data storage. [3.2] Data networks and remote diagnostics platform for Covid-19 Wuhan Medical Cloud Network is mainly imaging screening Network Platform and its Medical Imaging The ERD provided a foundational Cloud Platform. Raw clinical data first hardware for the modular hospitals. On enters the Medical Private Network this basis, United Imaging utilized cloud Platform, and then connects to the Medical computing platforms to provide an all- Imaging Cloud Platform. Radiologists inclusive workflow for close-loop remote across different geographies have access diagnostics, including imaging scans, to this Platform to read and perform quality control, diagnostics, review, and remote diagnosis, and then transfer the data transfer. United Imaging collaborated with partners to use cloud platform Through the closed- Medical Private Network Platform took Medical Cloud Network, to support responsibilities in data security and data remote imaging diagnosis for Covid-19. At transfers. The Medical Imaging Cloud Platform safeguarded the legitimacy and government assigned specific hospitals as privacy on the cloud. The precise and the designated locations to use remote effective online network was accredited to diagnostics for Covid-19 cases, further the existing digital medical system optimizing the allocation of the already development in Wuhan City. The city has limited radiology examination resources. had a city-wide online medical data system infrastructure in place before 2019, Secure and efficient data transfer is a interlinking most of the public hospitals prerequisite of remote diagnostics. As the through its online system. United majority of modular hospitals were converted from existing public facilities (i.e. sports stadiums and exhibition Medical Private Network Platform and its centers), the internet networks in these Medical Imaging Cloud Platform (Figure 3). facilities were unable to meet the Wuhan Municipal Health Commission requirements of medical data transfer. mobilized and coordinated hospitals to Hence, United Imaging collaborate with improve resource utilization. They multiple Chinese telecommunication arranged designated partnerships between companies to use the latest 5G the offering and receiving hospitals for

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 48 Diagnosis and Treatment

Figure 3. Components and operation of Wuhan Medical Cloud Network remote diagnostics, switching from multi- directional partnerships to designated bi- Guanggu Hospital), and directional partnerships, clarifying roles helped conduct over 14,000 remote and task division. Such designated diagnosis. Remote diagnostics played an partnerships minimized the chance of instrumental role in outbreak control by repeating and neglecting tasks, and offering timely and accurate diagnosis to ensured the effective triage and diagnosis support efficient decision-making. of patients. The designated partnerships were not limited to hospitals within Wuhan [3.3] uAI Smart System by the United City, but opened to the rest of the Imaging Artificial intelligence offered powerful supporting tertiary hospitals from other support in the remote diagnosis of Covid- regions offered their support in remote 19 cases, especially in the area of radiology, diagnostics through connecting the quality control, and diagnostics. United uAI Smart System for remote diagnostics is comprised of two Taking Donghu district in Wuhan City as components, the Sky Eye Smart Platform an example, United Imaging bridged nine and the Smart Assistance Analytics System.

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 49 Diagnosis and Treatment

When using the ERD and operating its AI minute lesions can be detected and function, the Sky Eye Smart Platform will automatically labelled to assist doctors in conduct facial and body recognition on screening, diagnosing, and prioritizing the patients without removing their masks suspected positive cases. In addition, for to ensure they are properly situated for the confirmed cases, the System can evaluate CT Scan. The radiologists can also perform and provide gradings according to the the CT Scan remotely in an isolated Covid-19 Severity Index. During the operation room without entering the ERD. outbreak, combining clinical features, the This greatly reduced not only the System categorized the Covid-19 cases operation time, but also the risk of into mild and severe categories to triage transmission. The enhanced workflow and formulate treatment plans. On each facilitated smooth operations, and hence image, the System would display the allowed a larger quantity of scans. It is automated labelling of pulmonary worth mentioning that the Sky Eye Smart radiological abnormalities, anatomical Platform was not created specifically for location, estimated area of pathology, and the Covid-19 outbreak. It was originally comparisons with scans in the database. designed for China construction of a The information provided valuable tiered diagnosis and treatment system, as references to doctors in diagnosing and part of the remote patient CT Scans evaluating each Covid-19 case. In the long guidance to reduce the number of doctors run, the accumulation of medical big data required at the primary hospitals. The on the platform can provide valuable basis timely implementation of Sky Eye Smart for developing radiology guidelines and Platform during Covid-19 outbreak has protocol for Covid-19. provided additional advantages in reducing the risk of disease transmission, [4] DISCUSSION as well as containing the outbreak.

During imaging diagnosis of Covid-19, how Platform was a cornerstone in combating to diagnose with more accuracy, at the the Covid-19 outbreak in Wuhan City. same time to assess disease severity while United Imaging was faced with many facing various images with atypical lesion challenges and difficulties in the execution features was a pressing issue. As a result, and implementation of the platform, such United Imaging designed and built the as supply chains, logistics, and access Smart Assistance Analytics System and resources. To overcome these challenges, United Imaging negotiated and liaised with partners in the gaming industry and the diagnosis efficiency. The Smart Assistance government to enable steady and speedy Analytics System was also developed to be implementations. To date, United Imaging compatible with various brands and continues to improve the Remote models of CT Scanners. Using highly Diagnostics Platform to combat the Covid- sensitive detection algorithms, subtle and 19 pandemic worldwide.

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 50 Diagnosis and Treatment

Medical Cloud Network. Therefore, United factors can merge with the existing online medical [4.1.1] Technical resource capacity informatics network with minor modifications, without the effort to build Platform employed many advanced one from scratch. Building the technologies in advanced imaging, infrastructure for a regional medical artificial intelligence, and informatics system is complex, time- telecommunications. The rapid consuming, and technically challenging. adjustments and coordination were Without the existing medical informatics enabled by the huge capacity of technical system of the city, United Imaging could resources and expertise United Imaging not have established the Remote already possesses. In advanced imaging, Diagnostics Platform for Covid-19 within United Imaging housed a wide variety of such limited time. CT imaging facilities, which allowed swift [4.1.3] Rapid decision-making and selection of the best set of hardware response equipment suitable for the ERD. In artificial intelligence, United Imaging gained With rapid development in Covid-19 competencies in the uAI intelligence outbreak, United Imaging executed rapid system. They finetuned the system for decision-making and response process rapid diagnosis of Covid-19 cases. In beyond commercial logic. At the early telecommunications, major Chinese onset of the outbreak, United Imaging telecommunication companies are in immediately mobilized its entire resources mature stage of development of 5G to fight against Covid-19, hastened the technologies. When processing the large decision-making process with the top- amount of data in medical imaging, the down approach for quick execution. The key characteristics of 5G technologies, selflessness and bravery of the employees including high speed, broad bandwidth, of United Imaging, and the generosity of and high securities, allowed efficient and the company to donate an array of secured medical data transfer. medical resources reflected the determination of United Imaging to [4.1.2] An established medical prioritize public well-being before the informatics infrastructure

Wuhan City has one of the most ideal [4.1.4] Collaborate and government medical informatics systems in China. In partnership accordance to the national direction to digitalize medical data, Wuhan City has The construction and implementation of had a basic online medical informatics system in place since 2019, which later hospitals and its Remote Diagnostics became a major component in the Wuhan Platform for Covid-19 involved several

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 51 Diagnosis and Treatment

government departments, including the Effective collaboration with United Imaging and different government Commission, Civil Affairs Bureau, departments was paramount in Municipal Development and Reform implementing the Remote Diagnostics Commission, and other local governments. Platform for Covid-19. The construction of Close collaborations between these the ERD and the Remote Diagnostics departments and United Imaging was the Platform required various government key to accomplish such complex departments to collaborate and undertaking. Prior to the Covid-19 outbreak, coordinate medical resources, the collaboration between United Imaging construction, and logistics support. Relevant government departments also Wuhan Medical Cloud Network had already needed to efficiently mobilize medical fostered trust between the two institutions. resources through designated locations During the lockdown of the city, without and provided administrative level any air and rail transportations, United guidance for hospitals to accept and Imaging faced an unprecedented adopt the Remote Diagnostics Platform, challenge in importing the construction eliminating any potential obstacles for materials, equipment, engineers, operators, implementation. and suppliers into Wuhan City to build the ERD for the modular hospitals, as well as [4.1.6] Supply chain security the Remote Diagnostics Network. During During the outbreak, most of the this critical period, United Imaging manufactures were closed, the supply proactively engaged the local government chain for both medical imaging equipment at different levels to negotiate logistic and ERD construction was in great plans to facilitate transportations. The uncertainty. Any hurdles in the supply relevant government departments offered chain can greatly impact the efficiency of invaluable support and coordination and the construction of the ERD and the opened a green channel for United Remote Diagnostics Platform. To tackle Imaging to effectively resolve any abrupt this challenge, United Imaging negotiated changes during the transportations, and to with suppliers genuinely, and with its ensure the smooth passage of resources existing reputation, United Imaging was and manpower to enter Wuhan City. able to influence and empower the [4.1.5] Collaborations between various suppliers to join its mission and fight government departments to mobilize against Covid-19. medical resources [4.2] Necessary conditions to replicate As the outbreak progressed rapidly, there was overwhelming workload across different governmental departments and successfully implemented because of the hospitals to react urgently to the crisis. aforementioned key success factors.

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 52 Diagnosis and Treatment

However, in order to replicate United [4.2.3] Financial sustainability factors will be indispensable: 1) telecommunication and informatics efforts required resources, equipment, capacities; 2) professional medical technical expertise, and a sizeable amount equipment and personnel; 3) financial of financial reserve. Regardless of forms of sustainability. financial support, whether it is collaborative donations or government [4.2.1] Telecommunication and purchases, the demand for financial informatics capacities capacity from United Imaging was still high. As a result, any spending needed to be monitored stringently to avoid any telecommunication and informatics possible hiccups caused by funding gaps. capacities. Telecommunication capacities were used in the validations in medical [4.2.4] Overall planning data transfer between offline medical data and online Medical Cloud Networks. The hardware construction, software Information technologies were used in data configuration, and resources coordination processing and data management in the remote diagnostics. By building informatics Diagnostics Platform required close systems and platforms, medical data were collaboration and communication among able to be further analyzed. all stakeholders. This requires one party to undertake the overall coordination, to [4.2.2] Professional medical equipment monitor and to push forward the and personnel implementation. In this case, the party was

Remote Diagnostics Platform requires professional medical equipment and the coordinator needs to have strong personnel. Imaging facilities and execution and supervision capabilities, to equipment determined whether a patient guide the orderly participations of can receive timely radiological diagnosis stakeholders. At the same time, this role and contribute towards medical data needs to have enough authority to source. At present, AI technology is still an assemble and reallocate medical auxiliary tool, therefore it cannot resources.

Therefore, radiologists needed to be [4.3] United Imaging remote diagnostics remotely operating the Remote Diagnostics platform and current stage of Platform. The lack of professional medical development equipment and personnel will directly hinder the implementation of Remote During the Covid-19 outbreak, United Diagnostics Platform. Imaging provided hardware and software support in medical imaging for Wuhan City

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 53 Diagnosis and Treatment

and the rest of the country, accumulating treatment partnerships with over 100 much experience in tacking pandemic domestic hospitals, and established crisis. Combining with its rich technical 19,000 healthcare service outlets reserve and the determination of the entire including WeDoctor general practice team to fight against the pandemic, United centers, community healthcare centers Imaging developed comprehensive end- and pharmacies. With its hardware and to-end solutions specifically for the software terminals, WeDoctor provides imaging diagnosis of Covid-19. Currently, hundreds of millions of families with quick the outbreak in China has somewhat access to 24/7 complete healthcare stabilized, United Imaging is proactively services. By May 2018, WeDoctor had built sharing its solutions with countries still fighting against Covid-19 to empower them with imaging diagnosis capacities. involving more than 2,700 key hospitals For instance, United Imaging visited Iraq and 240,000 doctors in 30 Chinese cities with the National team in March 2020 to and provinces. The number of real-name share their experiences, and donated its registered users had exceeded 160 million, ERD and digital mobile DR. On April 7, with a total of over 580 million people 2020, United Imaging sent the mobile benefiting from its services. digital CT Scanner to the epicenter of New York City. It served as the first 24-hour [1] BACKGROUND: The Medical Demands mobile digital CT Scanner for Covid-19 in of Various Population Groups During the , and operated in Covid-19 Have Been Met by Internet Maimonides Medical Center, the largest Healthcare hospital in Brooklyn, New York. The epidemic disrupted the normal order of medical services, leading to 5.3 discontinuation of many existing medical services (including inquiries for common Case Study III: WeDoctor diseases, revisits and maintenance medication for chronic diseases, etc.), and increasing demands for new medical ABOUT WeDoctor services (such as medical demands of WeDoctor is a healthcare technology people in home quarantine, diagnosis platform of Guahao () demands of suspected Covid-19 patients, Technology Co., Ltd. that provides users and psychological counseling demands of the public). Internet hospitals and medical platforms provide services such as free WeDoctor established Wuzhen Internet virtual consultation, online self- Hospital, the first Internet hospital in China, examination, teleconsultation and family and has launched branches in 19 cities and healthcare guidance through remote provinces. It has also forged medical technologies. These have alleviated the

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 54 Diagnosis and Treatment

shortage of offline medical resources, diagnostics, treatment, prevention and helped satisfy the medical demands of control of Covid-19, the supply of medical various patients, and allayed the panic services for patients with non- among the public. communicable chronic diseases became secondary. With nationwide practicing [2] CHALLENGE: During the Epidemic, home quarantine, reduced outpatient services at non-designated Covid-19 Various Medical Demands of Different hospitals, and fear of transmissions at Patients hospitals, many patients with chronic diseases were not able to receive proper Since January 2020, the rising onset of care. Moreover, with traffic control during Covid-19 was accompanied with travel Covid-19, logistics supply became restrictions, medical resources shortage, unstable, making the situation more and increasing medical demands of miserable for these patients. Patients with patients and general public. Specifically, cancers, diabetes and other diseases the medical demands of various gradually became desperate for their population groups during the epidemic medications and treatments. include: [2.3] While hospitals were over-capacity, [2.1] Basic medical demands of the the medical demands of patients with public could not be met because they mild or suspected Covid-19 symptoms were scared to seek treatments in could not be fulfilled medical institutions, for fear of cross infection The clustered outbreaks of Covid-19 caused a shortage in medical resources. During the peak of the epidemic, people Medical institutions in the affected areas could hardly go out because of strict local quickly became overwhelmed. While travel restrictions, and medical institutions institutions in non-affected areas, for fear were crowded with Covid-19 patients. If of hospital infection, strictly prevented there were any basic medical needs, such clustering of patients. In these situations, as common colds, inflammation, or minor medical demands of patients with mild or cuts, people stayed home and purchased suspected Covid-19 symptoms could not over the counter products online. This be met. Some people with Covid-19 like affected the living quality of local symptoms could not seek treatments due residents, and might have exacerbated to hospital restrictions or limited medical potential health issues. resources, while some would not go due [2.2] Medical resources became scarce to fear of transmission. for patients with noninfectious chronic [2.4] Public demands for mental health diseases, leaving their demands unmet emerged With medical resources prioritized for New public demands emerged from the

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 55 Diagnosis and Treatment

epidemic, such as mental health related other tests. There are also various built-in services. Many people had not expected functions for the doctors, such as AI-based the epidemic to be so over-whelming. smart auxiliary diagnosis system. This Negativity permeated, causing heavy system provides guidance to primary mental and emotional stress on the public. hospital doctors, assisting them to collect With the lockdown of Wuhan, and medical records, conduct preliminary unprecedented subsequent measures examinations, basic diagnosis, and simple taken by the rest of the country, such as treatments. For more complex cases, the regional containment, people doctors in the mobile hospital can access panicked. There were fear and anxiety for the built-in laptop in the workstation and themselves or their families and friends send requests to doctors at higher level over the risk of being infected. There were hospitals for teleconsultation support. If also feelings of loneliness due to home the mobile hospital is an older model or if quarantine, and helplessness due to the local network is unstable, the grass insufficient medical resources. root doctors can log in to the WeDoctor Global Consultation and Prevention Center [3] SOLUTION: Internet (GCPC) by scanning the QR code via Medical Service System WeChat to connect with superior doctors. During the Covid-19 outbreak, [3.1] Supplementary to primary hospitals, mobile hospitals arrived in cities and mobile hospitals provided basic medical provinces such as Tianjin, Hubei, Henan, services and Covid-19 screening Gansu, Xinjiang and Tibet. The mobile hospitals provided basic medical services needs and potential Covid- for local residents, thereby reduced the diagnostic needs, WeDoctor provided a flow of patients, and lowered the risks of unique solution: mobile hospitals. As a transmission. special service of WeDoctor, the mobile Mobile hospitals also participated in hospital is a medical treatment vehicle Covid-19 screening. In addition to equipped with smart examination and preliminary screening of residents in the testing system. It also has a cloud-based neighborhood, mobile hospitals also took HIS and health maintenance system, as care of the testing on travelers at traffic well as a drug and medical supply system. nodes, and helped disease control The mobile hospital covers seven major authorities with Covid-19 surveillance. To examination and testing items and 53 be specific, WeDoctor mobile hospitals minor ones, as well as standard diagnosis became local Covid-19 checkpoints. All and treatment services for 100 diseases. drivers, passengers and residents who The vehicle functions are similar to the wanted to pass and enter different ones in a small secondary hospital, jurisdictions had to be tested at the offering blood oxygen, blood routine, checkpoint locations by the mobile urine routine, type-B ultra-sound, ECG, and hospitals. The travelers would only be

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 56 Diagnosis and Treatment

permitted to move on if results came out Over 80 WeDoctor mobile hospitals were normal. If there were suspected patients deployed in Gansu, Henan, Ningxia, Hubei with high fever and other Covid-19 related and other areas for Covid-19 prevention symptoms, the information would be and control. They were incorporated into submitted to the information system of the the public health and primary medical mobile hospital, using its AI analytics to service systems, as part of the government assess the situation. For suspicious cases, efforts in epidemic prevention and control. the doctors would advise the individuals It is worth noting that WeDoctor mobile and report to the local disease control hospitals, originally served primary authority. To report suspected cases, the medical services, and unable to help with - Covid-19 nucleic acid testing as they were function in the system. Once the not designed with the function of suspected cases are uploaded in the infectious disease testing. However, as system, the back-end employees will epidemic situation stabilizes in China, contact local CDCs based on the reported WeDoctor plans to add this to its mobile locations. At the same time, doctors hospitals as a key basic function in future. working in the mobile hospitals would give This mainly requires applicable testing self-protection instructions and send consumables to be used in mobile potential carriers to designated hospitals hospitals. assigned by local government, for quarantine and further examination.

Figure 4. WeDoctor Mobile Hospital

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[3.2] As the only nationwide online clinic, of daily outpatients in Tongji Hospital of WeDoctor served the medical demands Huazhong University of Science and of a considerable number of patients Technology, a Wuhan-based AAA tertiary with noninfectious chronic diseases hospital, is 15,600. It was evident, the medical demands of chronic disease To combat the epidemic that swept the patients in Wuhan during the epidemic country, many tertiary hospitals and were substantial. infectious disease hospitals have been selected as the first batch of designated Since February 6, the WeDoctor Smart Covid-19 hospitals. Before Covid-19, these Clinic of WeDoctor Internet hospitals has hospitals provided a wide range of been successively launched in cities such medical services. During Covid-19, they as in Guangdong Province, closed general clinics, yet the medical Tianjin Municipal City, and and demands of patients did not decrease. To in Shandong Province, providing services resolve this problem, online such as treatments for common diseases, clinic offered specialized treatments, treatment for revisiting patients with chronic diseases management and drug chronic diseases, and drug delivery to delivery, providing the much-needed more than 100,000 patients. medical support for these patients. The purpose of the WeDoctor Smart Clinic By the end of January, there had been is to satisfy the urgent medication needs more than 400,000 patients with severe of chronic disease patients. However, chronic diseases in Wuhan, the first during the epidemic, one of the major epicenter of Covid-19. However, these challenges for WeDoctor was drug delivery, patients had to wait for over a month to especially in Wuhan, as the city was in receive offline prescriptions. Upon the complete lockdown. The outbreak during launch of the WeDoctor Smart Clinic, the the Chinese New Year prevented many Wuhan municipal headquarters for the delivery service workers from returning to Novel Coronavirus Disease (Covid-19) Wuhan, reducing delivery efficiency. Epidemic Prevention and Control sent Meanwhile, the local logistics companies announcements to the entire city via were overloaded with delivery tasks for urgent medical supplies and were unable networks. It announced that patients with to help. Facing such challenges, WeDoctor severe chronic diseases can conduct tele- chose to work with local leading courier consultations and apply for medical companies, bypassing retail pharmacies, insurance reimbursement. Merely on and deliver drugs directly to patients from January 26, the day WeDoctor Smart Clinic its central warehouse. To adjust for this was launched, there were more than service, WeDoctor allocated a large group 13,000 inquiries, with the total number of of employees in Hubei Province to help inquiries exceeding 26,000 within 24 with logistics and delivery coordination. hours. In comparison, the average number

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Another major challenge was to identity doctors were invited to give medical authentication. It is necessary to advice on the Platform in their off hours. authenticate patient's medical insurance On one hand, the Real-Time Aid Platform identity during inquiry and prescription to promoted the creation of a complete mitigate potential insurance fraud. During closed medical service loop that connects the epidemic, with support from the Internet hospitals with offline ones. This National Healthcare Security service enabled patients with common or Administration (NHSA), WeDoctor worked chronic diseases to access regular medical services without leaving home, thereby their system with medical reduced unnecessary population flow, and insurance system. The medical insurance minimized cross infection possibilities. On e-certificate enables facial or real name the other hand, by providing Covid-19- related online consultation or free clinic status. This process was aimed to ensure services to the whole society, the Platform and protect both the patients and the educated the public on self-protection and security of medical insurance funds. On timely identified patients with mild the newly-launched Shandong Healthcare symptoms. Security platform, the historical medication information of a patient in the During the peak of the outbreak, the past 3 months can be obtained within 0.02 biggest challenge for WeDoctor was second. The whole process, from exploring ways to face the soaring inquiry demands and to mobilize medical completing all the settlements with the personnel. Shortly after the Platform was launched, WeDoctor began inviting and personal account, takes less than 3 specialists, such as respiratory, infection, minutes. general internal medicine, and intensive care unit, to provide free unlimited [3.3] Internet healthcare has helped teleconsultation services for local create a closed medical treatment loop, residents. 1,500 specialists were selected, triaging patients to alleviate the stress out of a pool of 300,000 WeDoctor on hospitals contracted doctors. Within the first three days of launch, tele-consultation averaged To tackle the epidemic, WeDoctor Internet about 10 million times per day. It was clear - that the demands were over-whelming and Time Aid Platform for Covid- very difficult to meet. Facing this (hereinafter referred to as Real-Time Aid challenge, WeDoctor quickly expanded its Platform or Platform) on January 23, 2020. doctor base through the following three The key function of the Real-Time Aid methods: 1) Widening the selection scope Platform is to help triage patients, identify of doctors to any doctor who had mild symptoms, offering rapid responses experienced rotations in the infectious to inquiries within 3 minutes. Qualified disease department. WeDoctor rapidly

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announced doctor recruitment via its with over 54,000 doctors providing tele- portal to invite more qualified doctors to consultation to a total of 1.73 million the Platform, and arranged them to work visitors. During this outbreak, all online immediately; 2) Call out for more consultations were free of charge, with the doctor participation in tele-consultation in cost equally assumed by WeDoctor and specific communities, such as doctor the Minsheng Public Foundation. Though communities; 3) Recruit through official the Covid-19 outbreak has somewhat channels such as local health com- normalized in China, this Platform is still in missions of areas with Covid-19 prevention service. On June 17, based on the statistics and control needs, including collected, total visits to the Platform had Province, Shandong Province, Tianjin exceeded 144 million times. Over 61,000 Municipal City, and Longyan City in Fujian doctors provided tele-consultation to a Province. The local Health Commissions of total of 1.968 million visitors. these locations collaborated with WeDoctor, releasing policies to request doctors from local secondary hospitals or above to join the Platform. Some industry associations also offered support. Many local associations such as the Chinese Medical Doctor Association and the China International Exchange and Promotion Association for Medical and Healthcare, helped mobilize more doctors to participate and provide teleconsultation on the Platform. Source: Image the Internet, Available at https://www.sohu.com/a/277506559_685386 Based on statistics collected at 11:00 pm on February 5, 2020, the Real-Time Aid Figure 5. Internet Medical Services Platform operated by WeDoctor Internet General Hospital, had provided medical [3.4] Mental health assistance zone consultation services to a total of 1.002 million visitors, with the daily treatment On the early morning of January 27, 2020, capacity reaching 100,000. In comparison, WeDoctor Internet General Hospital at the end of January, the daily number of launched a mental health assistance zone, outpatients at hospitals with fever clinics in collaboration with the in Wuhan was at 10,000. Evidently, the Kangning Hospital Group, the Zhejiang demand for tele-consultation during Psychological Health Promotion Covid-19 was much too overwhelming to Association, and the Mindful Heart Power be handled by local hospitals alone. By the psychologist volunteer team. The services morning of April 12, 2020, visits to the included self-assessment and prognosis, Platform had exceeded 135 million times, expert consultation, psychological support

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services, and 24/7 psychological telemedicine. With the onset of a major consultation. The 100-member public health emergency like Covid-19, the psychologist team mainly consists of innovative value of Internet hospitals has psychiatrists and psychological truly been realized for the first time. consultants, over 20% of which are Recognizing the significant role of Internet clinicians, providing free consultation hospitals during epidemic crises, services to all users. There are now two government departments, such as the services available in the mental health National Health Commission (NHC) and assistance zone: self-assessment and the NHSA, issued a series of policies to prognosis, and expert consultations. For support the use of telemedicine and post-traumatic stress disorder (PTSD), Internet hospitals, with WeDoctor leading anxiety and depression, which are most the fight against Covid-19. The policy commonly observed in the Covid-19 support from the top level has expedited affected areas, users can answer 7 to 17 local health authorities to work with self-assessment questions as preliminary WeDoctor, and accelerated project assessment. Once complete, based on the implementation. For example, as self-assessment survey, the system will mentioned above, the local Health suggest whether psychological Commissions in Heilongjiang, Shandong consultation is recommended. and Tianjin have released policies to call for participation of local doctors and [4] DISCUSSION medical institutions to integrate their online and offline services. success factors In addition to supportive policies, local governments offered financial and WeDoctor Internet hospitals provided a insurance assistance to WeDoctor. During wide variety of services for different the outbreak, many local governments population groups throughout the purchased mobile hospitals to epidemic outbreak. Its services effectively provide primary medical services to local triaged population flow away from local residents. In Wuhan, medical services of medical institutions and provided services the WeDoctor Smart Clinic were for the non-critical Covid-19 population. incorporated into the medical insurance The key success factors mainly include: coverage, which lessened the financial [4.1.1] High-level policy and funding concerns of patients. In additional to supports from the government for official organizations, some industry Internet hospitals, as well as multi-party associations have also supported collaboration WeDoctor with various resources. The Minsheng Public Foundation provided 50% As a link in the healthcare system, Internet subsidies to the doctors participated in hospitals have consistently played an free teleconsultation. Some financial important role in basic healthcare and institutions, including the five largest

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state-owned banks, Shanghai regions. During the epidemic outbreak, Development Bank, China Guangfa Bank, this feature helped WeDoctor understand and American International Assurance, better the trends of disease prevention added free tele-consultation and control across different areas, and services page to their official App, stay informed of the local demands. extending services to a wider range of population. Many media outlets, [4.1.3] solid achievements in such as China Daily, China Economic Net, building industry infrastructure Sina Weibo and Tencent, WeDoctor leveraged its mature digital also participated and voluntarily platform to create a digital closed loop recommended free tele- that links medical services, examination, consultation services to users, to help testing and medical insurance payment WeDoctor widen its coverage. With all services together. Each service is these assistances to free tele-consultation coordinated and connected to ensure the services, the WeDoctor Platform has helped more populations in need, which to and to deepen its linkage with industry some degree mitigated much of the resources. Therefore, in the face of the epidemic-induced public panic and fear. unexpected crisis, WeDoctor was able to [4.1.2] Unique value of platform-based quickly and sufficiently utilize its digital Internet hospitals platform to achieve efficient collaboration with local Health Commissions, healthcare In terms of resource mobilization and security administrations and medical matching, digital health platforms have institutions, making its services synergistic, realized large-scaled consultation and professional, and easily accessible. screening capacity, and contributed to the [4.2] Necessary conditions to replicate emergency system. Generally speaking, model due to travel restriction during the success in extending a wide outbreak, more and more patients chose variety of services to different populations to seek treatment and medication services in the epidemic lies on the following via Internet hospitals, largely increased the conditions: relative value of Internet. Moreover, when collabo-rating with local partners, [4.2.1] Digital-enabled telemedicine platform-based Internet hospitals can use platform the same technical and operation system and apply to the local diagnosis and various service solutions are treatment systems. Furthermore, all based on its existing sophisticated systems are controlled by the same telemedicine platform. The Platform has a backend, so that the operation of the local solid and powerful foundation. Even with systems can be monitored across various the large-scale usage across the country,

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with visits reached the upper limit of the [4.3] Social responsibilities and Platform, it can still operate steadily. In development of WeDoctor Internet addition, communication and information hospitals services technologies are indispensable for the operation of the telemedicine platform, In the battle against Covid-19, due to lack ensuring effective data transmission and of relevant knowledge and insufficient interaction, and smart management. information available, unfounded and unscientific information was propagated [4.2.2] Sufficient doctor resources via Internet and other channels. In an effort to stop the spread of rumors and By signing contracts with doctors, the provide the public with scientific disease WeDoctor platform maintains a stable prevention and control information, the employment relationship with a large Chinese version of the Handbook of number of doctor groups. When a public Prevention and Treatment of the health emergency arises, such a sizeable Pneumonia Caused by the Novel reserve can be quickly mobilized. However, Coronavirus (2019-nCoV) was released on it was also due to industry the anti-Covid-19 public benefit inquiry reputation, the company was able to platform of WeDoctor Internet General attract much attention from other non- Hospital on January 27, 2020. In the contracted local doctors, as well as other following week of its release, the public and private stakeholders. Through handbook was downloaded 342,000 times. support and collaboration, WeDoctor was On January 29, 2020, WeDoctor published empowered to tackle the challenges the Handbook of Prevention and brought on by the crisis. Treatment of the Pneumonia Caused by the Novel Coronavirus (2019-nCoV), the [4.2.3] Financial guarantee -cation on Covid-19 Among the services offered by WeDoctor, prevention and control that is written in mobile hospitals are the most expensive both Chinese and English. The Handbook and require a high level of financial can be downloaded for free. By providing support. The operation and human costs foreigners in China and the overseas of the inquiry platform are also two of the Chinese with professional, scientific, and key factors for implementation. More informed guidance on Covid-19 prevention importantly, WeDoctor manages to link its and control, this handbook helped the services with social insurance in different public strengthen self-protection and regions to help support patients with reduced the risk of disease transmission. chronic diseases financially. This is a Since March 2020, although Covid-19 precondition for the success of the outbreak has gradually stabilized in China, WeDoctor Smart Clinic. there have been multiple outbreaks in the rest of the world. To help the 60 million overseas Chinese and the international

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society combat the epidemic, on March 14, assistance platform sponsored by the NHC. 2020, WeDoctor Internet General Hospital, joined hands with China International Since its launch, apart from diligently Exchange and Promotion Association for serving the public at home and abroad, Medical and Healthcare and China Alliance the WeDoctor GCPC has been invited to of Renowned Doctors, launched the Chinese and English versions of the experience in fighting against Covid-19 WeDoctor Global Consultation and with medical professionals across the Prevention Center (WeDoctor GCPC). globe. To date, it has organized 12 online Together, they also launched a webinars to share experiences in Covid-19 psychological consultation zone. Medical prevention and treatment with medical experts at home and abroad are gathered professionals from countries and regions on this platform to provide services such as , North America, , targeted at the pandemic crisis, including , , Kenya, , Uganda online consultation in multiple languages and . Each webinar was viewed for to equip the overseas Chinese and other over 10,000 times, on average, and have visitors with necessary healthcare aided more than 30 countries and regions information. By June 15, 2020 the with their fight against Covid-19. WeDoctor GCPC had gathered 10,816 experts, including attending doctors or 5.4 higher in position from Covid-19 related disciplines, such as respiratory medicine, Case Study IV: Zuo Shou Yi ENT, internal medicine and general Sheng practice, and professional psychological consultants. Over 3.47 million visitors from ABOUT Zuo Shou Yi Sheng more than 220 countries and regions had benefited from the free teleconsultation Zuo Shou Yi Sheng (ZSYS, or Left-Hand services, accumulating over 14 million Doctor) is a product developed by Beijing visits. ZhuYi Technology Co., Ltd. It integrates deep learning, big data analytics, natural- various attempts to fight language understanding, and medical Covid-19 leveraging its digital platform interactive dialogues to bring smart throughout the pandemic have been medical technologies to the healthcare highly praised by the government. The industry. Zuo Shou Yi Sheng (ZSYS) is an Ministry of Foreign Affairs and over 170 open platform which currently covers Chinese embassies and consulates more than 35 disciplines and consists overseas have recommended the 6000 common diseases. The platform WeDoctor GCPC via their official websites offers five main services: smart self- and social media accounts. They have also diagnosis, smart consultation, smart pre- placed the information on the top of the diagnosis, smart pharmaceutical Q&A, and service platform list on the overseas smart Q&A. Apart from its smart

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services, ZSYS also provides its solutions [2] CHALLENGE: Insufficient Medical to public hospitals, pharmacies, family Supplies Verses Increasing Medical doctors, smart technology hardware Demands companies, and information technology firms. An example is its rapid medical Panic-induced hospital visits, rising treatment solution, which helps patients demand for medical services, and finite receive timely treatment before, during, supply of medical resources were and after the diagnoses. This also helps unavoidable challenges during an hospitals accurately receive appropriate epidemic outbreak. Facing these problems, the already chaotic hospitals and smart follow-up, rehabilitation guidance, overwhelmed medical personnel were reminders, and health knowledge related even more unprepared to properly services, which help hospitals manage respond to and manage the flood of outpatients more effectively. suspected patients, discharged patients, and quarantined population. Specifically, [1] BACKGROUND: Internet Hospitals there were two main problems: Help Reduce and Mitigate Hospital- Acquired Cross-Infections During the [2.1] Panic-induced hospital visits cause Covid-19 Outbreak, Leaving More cross infection Medical Resources and Services for The Since the outbreak of Covid-19, panic and Patients in Need fear prevailed in public sentiment. Overwhelmed by the amount of mixed increased exponentially during Covid-19. public information and insufficient With increased patients and suspected medical knowledge, the general public ones crowding hospitals, hospitals and was prone to rush to hospitals to consult healthcare personnel became with experts as soon as they observed any overwhelmed, leading to insufficient cold-like symptoms. Panic and fear drove services and treatments. Internet hospitals, crowds to hospitals and increases the risk using Artificial Intelligence (AI) technology, of cross infection, which further hindered offer patients with Covid-19-like symptoms efforts to prevent and control the general medical knowledge and self- epidemic. quarantine instructions. This service not [2.2] Lack of medical resources to only reduces the risk of Covid-19 patients follow-up and effectively manage infecting others, but also breaks quarantined and discharged patients geographical boundaries on medical resources, allowing more effective Those who have been in close contact distributions of those resources, thereby with Covid-19 patients are required to self- eases the stress on the hospitals. quarantine for fourteen days. Those who were under quarantine, however, were unable to receive their medical needs

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during this period. Similarly, discharged [3.2] Smart pre-diagnosis system patients might also require medical follow- ups, yet they were also unable to receive the treatments and care they need. During upgraded and adapted its Covid-19 Smart the early onset and the peak of Covid-19 Screening System as Smart Pre-diagnosis outbreak, hospitals were over-burdened System for the hospitals. The System and found it hard to respond to the reduced human resources involved in medical needs given their strained Covid-19 diagnosis consider-ably, and medical resources, majority of which were increased doctor consultation productivity. prioritized for the Covid-19 patients. In the Smart Pre-diagnosis System, ZSYS [3] SOLUTION: AI-based "Covid-19 Smart added personalized questions to the Screening System" and "Covid-19 Smart Smart Screening System for fever clinics, Follow-up System" becoming the new upgraded tool. The new upgraded System asks questions Given the challenges above, ZSYS built based on Covid-19 clinical observations, upon its existing AI self-diagnosis and guided treatment solutions and developed multiple remote medical services. In helping doctors collect key relevant information from their patients prior to the [3.1] Covid-19 smart screening system actual consultations, the System drastically saved time and energy for the For suspected Covid-19 patients, ZSYS doctors. developed a Covid-19 Smart Screening System that can be accessed and used via The patients still need to make WeChat. When patients observed fever, appointments with the hospitals. However, cough, fatigue, nasal congestion and other once a patient books one, he or she can suspected symptoms of Covid-19, they get access to the Smart Pre-diagnosis could use the System to determine their System. The System is accessible through next best steps. The System simulates doctor consultations and generates a final by scanning the WeChat QR code at the conclusion, including medical and hospital. Patients can then inform the quarantine advices. This prevented people System the reasons behind their hospital from blindly rushing to hospitals and visits, and based on that information, the reduced the risk of cross infection at System generates personalized questions hospitals.

The system was launched on January 21, medical history, allergies, and family 2020. By the end of February, the Covid-19 medical history. The System then creates Smart Screening System has covered over an Electronic Medical Record (EMR) for the 150 hospitals across 20 provinces in China, recording formats. with user volume exceeding one million.

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-diagnosis System utilizes [3.3] Covid-19 smart follow-up system deep learning and other machine learning strategies on large volume of medical On February 19, 2020, the National Health literatures and records, creating a reliable Commission (NHC) added a new network of medical knowledge. This recommendation to the sixth Covid-19 further allows the System to simulate Diagnosis and Treatment Protocol. The NHC recommended that discharged consultations and reproduce the Covid-19 patients must continue to consultation process for the patients. At monitor their own health status for 14 days the end of the consultation, the system after their discharge, and the patients generates a medical record for each must be followed up at the end of the patient. Using the Smart Pre-diagnosis second week and fourth week after their discharge. In response to these new the process of diagnosis and allows recommendations, ZSYS promptly patients to have some understanding of launched a Covid-19 Smart Follow-up their own medical status before System which helped the hospitals to communicating with their doctors. The conduct online follow-up consultations for System also saves doctors from spending the discharged patients, offering services time on writing medical records, thereby such as smart follow-up consultations, improving medical efficiency. disease management and monitoring. The System greatly reduced contacts between During the Covid- patients and doctors, and in turn reduced Smart Pre-Diagnosis System helped the workload of hospitals. produce over ten thousand medical records on a daily basis, with less than 10% The Covid-19 Smart Follow-up System has of the records require corrections. The two components: a patient-facing most basic functions of the system also component and a hospital-facing supported medical photo uploads and component. The System can be accessed past examination records. With the via either a mobile device or a desktop upgrade, the System was programmed to computer. It is also accessible through the analyze key patient information with these records and prompt new questions based on that information. For the patients, the account, the user is connected directly to process saved them from repeatedly the Hospital Information System (HIS), entering personal information and medical which then allows hospitals to send follow- history. For the doctors, the system helped up reminders directly to the discharged collect as much outpatient information as - possible to support medical decisions and powered doctor assistants also regularly research. discharge, such as symptom changes, contact history, medications, and

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examination appointments, and send them instance, after learning about the fact that people flooding to hospitals putting more doctors to receive up-to-date information pressure on medical personnel, ZSYS and monitor their patients accordingly. updated its Covid-19 Smart Screening System to a Smart Pre-diagnosis System Patients can also sign up and participate in to help triage and divert hospital flow. 2) the Covid-19 Smart Follow-up System via ZSYS also developed new functions for short message service (SMS) or scan QR code via WeChat. By signing up, the needs and circumstances. For example, discharged patients can receive when working with Wuhan Tongji Hospital, information from hospitals such as their ZSYS developed the Covid-19 Smart own medical follow-up schedules and Follow- recovery progress. On the medical follow- Covid-19 Diagnosis and Treatment up and management page, patients can Protocol updates. consultation services and help doctors [4.1.2] Close collaboration with hospitals better understand their health situation. in updating its solutions

[4] DISCUSSION -established work relation-ship with multiple hospitals across China became important during the Covid-19 crisis. As hospitals needed to modify its During the Covid-19 outbreak, ZSYS work scope based on the disease developed various solutions catered to development and any government policy different population segments and served changes, ZSYS was able to quickly and over one million users, covering over 150 accurately understand the changes in hospitals across 20 provinces. The main demand and develop corresponding reasons behind its success are as follows: solutions for the hospitals. For instance, [4.1.1] Classification of solutions based after the NHC published its sixth Covid-19 on different needs Diagnosis and Treatment Protocol, hospitals had to institute follow-up visits During the epidemic, patients and for discharged patients and were in need hospitals have different needs, and ZSYS of support from AI and internet was able to respond to these needs by technologies to meet those protocols. separating its solutions into two categories, based on their demand [4.2] Necessary conditions to replicate expectations. These two categories of In order to implement a similar project in solutions are then managed by different other countries or regions, certain product managers: 1) ZSYS updated and conditions need to be considered: developed new solutions based on

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[4.2.1] AI technology as a foundation 5.5 During the outbreak, AI and big data technologies helped replace repetitive Value of Digital technology in labor by analyzing past data and quickly Diagnosis and Treatment finding solutions and predictive measures. In the future, other countries and regions 5.5.1 To the healthcare system can also incorporate AI technology as needed to improve the efficiency of The application of digital technology in existing human resources and replace diagnosis and treatment effectively eased repetitive menial tasks. the imbalance of medical resources during the epidemic, and promoted the [4.2.2] A social media or information development of normalized telemedicine. platform with high market penetration In the short term, the use of digital One of the reasons that ZSYS was able to technology enabled remote diagnosis and reach more than one million users was that treatment, and thus effectively improved it chose WeChat as its launching platform. the capacity and efficiency of frontline WeChat has a high market penetration and medical institutions while guaranteeing user volume within China, and is also very the safety of frontline medical employees. user friendly. Users were able to enter the In the long term, the participation of system by simply scanning a QR code via digital technology also accelerated the WeChat. Other countries trying to execute pace of normalizing telemedicine. Under similar projects should consider whether the urgent situation of the epidemic, the such a platform exists within the healthcare system accelerated the sinking community. If not, they could consider of high-quality medical resources to areas building a platform for targeted population through remote consultation and other segments during the outbreak. means, so that critically-ill patients in remote areas can also receive timely and [4.2.3] Hospitals need to be equipped effective treatment. This laid the with HIS systems foundation for the normalization of telemedicine after the epidemic. ZSYS was able to link its system to the HIS of the hospitals, which made it easier for 5.5.2 To the public the doctors to use as they are already familiar with HIS. Countries or regions For suspected patients and mild patients without HIS should carefully consider the who needed home quarantine, the feasibility of internet hospitals or build participation of digital technology can temporary data systems in hospitals. provide them with timely, convenient, and reliable home care knowledge and services, reducing both panic and the possibility of transmission to family

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members. For non-Coronavirus patients technology are not fully available, being with common diseases and chronic able to quickly build a network is currently diseases, the participation of digital an urgent problem that needs to be solved. technology can provide continuous online Especially in remote areas where medical monitoring, diagnosis and treatment resources are scarce and medical experts services to help patients avoid being are in need, the conditions for the rapid exposed in the crowd and reduce the risk establishment of communication and of cross-infection. information technology are also lacking.

5.6 Limitations and Challenges

5.6.1 Limitations of online consultation

Due to its own limitations, online consultation can only play a limited preliminary role on screening and pre- diagnosis. Even for offline fever clinics, it will take a long time for doctors to ask patient's previous experiences and medical histories when doing the screening. Although online consultation can help relieve the pressure of offline hospitals and reduce the risk of cluster infection, there may be treatment delay for patients with the Coronavirus due to unclear descriptions of unclear symptoms, and limited time and means for the consultation. Therefore, the areas and modalities of the participation in online consultation need to be further explored.

5.6.2 High technology requirements

The participation of digital technology in diagnosis and treatment relies on high requirements of communication and information technology, such as the teleconsultation based on 5G. In areas where communication and information

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 70 SUPPORTIVE ACTIVITIES Supportive Activities

During the outbreak prevention and control period, timely disclosure and dissemination of information, professional knowledge training, sufficient resources supply, and management of special population groups and other supportive activities are of vital to all sectors of society. In this chapter, the study focuses on how digital technology participates in the following six supportive activity areas during the Covid-19 pandemic: population flow information, information communication, medical personnel training, hospital information, resource supply, social mobilization, and elderly population group management.

6.1 Digital Technology in Supportive 6.1.2 Provide the public with timely, Activities accurate, detailed, and objective information

6.1.1 Provide the public with intuitive Timely and accurate information personnel movement and distribution communication is an important means to ensure the public's emotional stability and Due to the highest contagious nature of social order during a major public health Covid-19, avoiding human interactions and event. It is also a necessary basis for the crowd gatherings are important measures government to promote unified disease to prevent large-scale outbreaks. prevention and epidemic control measures. Therefore, information such as the quantity, Outbreak news published by new media the direction, and the aggregation degree platforms, such as social media platforms, of population flow is the crucial reference and news media, can reach a large-scale for the public when traveling during the audience, providing real-time epidemic outbreak. Artificial intelligence and big updates in a timely manner, and deliver data analysis technology help visualize the official information explanations. This flow and distribution of the population, offers public demand for trustworthy and helping the public intuitively understand transparent information, while also the relevant information required for travel mitigates misunderstandings and mis- considerations. interpretations.

For instance, Baidu Map, Tencent Map, and For instance, DXY launched a "Covid-19 Amap Real-time Information Platform", which History of the Covid- included modules of "Rumor Dispelling maps, "Migration Maps", "Heat Map" layers, and Self-protection" and "Covid-19 "Epidemic Community Map" and other functions. Tencent News launched the "Real-time

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Covid-19 Rumor Dispelling"; grassroots medical personnel, and in turn -19" successively launched further promote professional public health -time Broadcast for knowledge to the public. Covid-19 for the Country and Provinces", "Covid-19 Prevention and Treatment & In- For instance, DXY launched free public depth Analysis", "Covid-19 Rumor Crusher". online courses for Covid-19 diagnosis and Tencent Health, Baidu Maps, and Amap treatment, providing professional training develop-ed and launched the "Fever Clinic for medical personnel, conveying public Map" and provided the public with timely health knowledge to the public; JuniperMD official hospital information. The maps, teamed up with China Primary Health Care later in the outbreak, achieved Foundation and ASK Health to jointly synchronized population flow information. launch charitable live broadcasts on heated topics and public concerns around 6.1.3 Provide professional training for Covid-19. medical personnel and disseminates professional public health knowledge to 6.1.4 Set up the reliable resource the general public supplement and donation platform

Covid-19 came without much warning. The The outbreak of the Covid-19 pandemic in medical personnel, especially those on the China coincided with the Chinese New grassroots level, lacked the relevant Year holiday. With supply chains closed for knowledge of the virus let alone the the holiday, the supply of medical supplies capability to manage it. Thus, they was challenged to a great extent. In urgently needed to supplement addition, due to short-age of manpower, professional knowledge, skills, and resource donations and supplies needed experience to ensure their own safety, and more support for audit and supervision to enhance the effectiveness of prevention ensure the quality of the donations. and control measures. In addition, as the Leveraging the Internet platform, the public generally lacked sufficient public collection, integration, distribution, and health knowledge, they were easy matching of donation information can be misinformed by unverified misinformation. completed online, enhancing greatly the Therefore, officials and professional public efficiency of resource matching for those health experts desperately needed to in need. provide their inputs in order to stabilize For instance, Tencent Charitable, Sina public sentiment. The remote Micro Charitable, Easy Fundraising, communication technology enabled Gongyibao, Shuidi Charitable, and many doctors, infectious disease experts, and other charitable platforms joined many public health experts in the tertiary foundations to launch fundraising for hospitals in urban cities to provide online Covid-19. Viewhigh Technology and training lectures for a large number of Yonyou built an efficient emergency

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materials management platform to achieve medical students and medical personnel. efficient docking between hospitals and At present, DXY has developed into one of donors. the major professional Internet healthcare platforms in China, with high credibility 6.1.5 Provide assurance for the elderly and influence in the field of public health. during this critical period According to the latest data provided by DXY, its platform has more than 5.5 million The elderly population accounts for a high professional users, of which more than proportion of deaths from Covid-19, 1.47 million are certified physicians, therefore, the care management and covering 70% of physicians across China. services of the elderly were crucial during The services DXY provides can be roughly the pandemic outbreak. With measures divided into four areas: for doctors, for such as isolation and travel restrictions, general public and patients, for medical routine care services for the elderly were institutions, and for commercial services. greatly affected. Using ICT technologies Its services include Medicine Assistants, such as the Internet of Things and artificial DXY Forum, DXY Public Courses, DXY intelligence, remote care, and health Podcast, DXY Doctor, DXY Mother, DXY management can be carried out to avoid Family, DXY Clinic, DXY Talents, DXY contacts between caregivers and the Business Platform, DXY Hospital Library, elderly, while ensuring the quality of care. and Insight Database. For instance, IZhaohu provided remote [1] BACKGROUND: Timely and Accurate care for the elderly through smart sensors, Communication of Epidemic Information movement recognition, data prediction. Contributes to Emotion Stability of the They also provided online training and Public, While Rapid and Authoritative support through remote communication Training of Medical Personnel Improves technology to enable the family members the Efficiency of Outbreak Control to take care of the elderlies at home. The Covid-19 epidemic spread quickly and 6.2 widely. In the face of an unexpected outbreak, a plethora of information and Case Study V: DXY claims erupted across many platforms and media. Without timely supervision and adequate explanation, the information ABOUT DXY would be easily exaggerated and DXY, founded in 2000, is originally a misinterpreted. Meanwhile, due to medical knowledge sharing platform. Its inconsistency in the information and initial goal was to establish a medical communication platforms used across professional search website, via which to different regions, the accessibility of popularize search experience and information and the frequency of update knowledge sharing to a wide range of varied. This made obtaining and following

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the information on the epidemic situation [2.1.1] There were inconsistencies in the even more difficult for the public. caliber and standard of data reporting, Consequently, the outbreak information coupled with low levels of information received by the public was markedly visualization at the beginning of the divergent, some of which were highly outbreak unreliable and distorted, exacerbating public panic and fear. Information at the onset of the epidemic, the data and communication is an important means to information on the outbreak provided by ensure the public emotion stability, the provinces and municipalities were not especially when a public health standardized and were both complex and emergency arise. It is also a necessary diverse. When the public searched for foundation for the government to contents on the outbreak, the information implement a unified and centrally was often scattered and complicated, coordinated response to the outbreak. leading to misunderstandings, causing Therefore, there was an urgent need for distress and confusions among the public. the government to timely, accurately and This was not conducive to the active and appropriately communicate the outbreak effective prevention and control of the information at the onset of Covid-19. epidemic.

[2] CHALLENGE: Outbreak Information [2.1.2] Various false and misleading Was Not Communicated in a Timely and information appeared during the Accurate Manner, and Routine Training outbreak of Medical Personnel Was Difficult to In the early stage of the epidemic, there Implement were many technical terms in the official [2.1] Outbreak information was not statements released to the public. communicated in a timely and accurate Consequently, the statements released manner were difficult to understand, and sometimes inadequately explained by the The Covid-19 outbreak affected the entire officials, with nominal supervision in place. country. The methods and technology As a result, much information and data used for communicating information were fabricated, replaced, exaggerated, varied significantly across different and misinterpreted, some of which were regions, made it difficult to achieve timely widely posted and forwarded on the and unified information dissemination Internet and media platforms. This misled right from the beginning. Insufficient and the public, especially those who were inaccurate information communication eager to search for information, resulting also increased the possibility of in misinformation and misunderstanding, miscommunication and misinterpretation further aggravating the already panicked of information. There were three main public. Ultimately, this negatively problems with information communication impacted disease prevention and during the Covid-19 outbreak: epidemic control. Even though there were

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experts available to dispel the misleading generally unfamiliar with the diagnosis and information, they usually focused on the treatment of Covid-19, leading to a information that had high social impact. certain degree of delay in diagnosis and or Further, the dispelled information were misdiagnosis. scattered and more often delayed, leading to inefficient communication to the public. -19 Real-time Information Platform and Online Special [2.2] Medical personnel training was in Courses great need, but difficult to carry out during the epidemic [3.1] DXY Covid-19 real-time information platform To control the epidemic, rapid and professional medical personnel training To resolve the issue of lack of timely and could greatly increase the efficiency with easy to understand communication of which patients are treated. However, due outbreak information, DXY established a to the urgency of the outbreak and the Covid-19 Real-time Information Platform on highly contagious nature of Covid-19, January 21, 2020. The platform consisted routine face-to-face medical personnel of four modules: Epidemic Map, Real-time training was difficult to carry out in a Broadcast, Rumor Dispelling and Self- timely manner. The Covid-19 epidemic first Protection, and Covid-19 Knowledge. All of broke out in Wuhan City and then spread the contents were updated and posted to the entire Hubei province. Many concurrently on a designated website for provinces across the country sent medical the platform, DXY App, the official public teams to support Wuhan City and Hubei WeChat account of DXY, official Weibo province. In addition to assisting the account of DXY, and other major social treatment of patients and controlling the media platforms. DXY Covid-19 Real-time outbreak from spreading further, these Information Platform was the first medical personnel also accumulated some professional platform to collect and experience in diagnosis and treatment. In integrate Covid-19 data, visualize the data the midst of a concentrated outbreak, the results, and set up a rumor dispelling and demand for Covid-19 diagnosis and knowledge module during the Covid-19 treatment protocols for medical personnel epidemic. across the country increased rapidly. [3.1.1] Epidemic map and real-time Nevertheless, due to high demand and risk broadcast modules of transmission, the medical team in Wuhan City and Hubei Province had to In order to effectively integrate the stay put for a long time, it was impossible information on the Covid-19 epidemic for them to return to their original from various locations, DXY Covid-19 Real- hospitals to conduct medical training time Information Platform offered immediately. As a result, medical Epidemic Map and Real-time Broadcast personnel outside of Hubei Province were modules.

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The Real-time Broadcast module covered channels. The global epidemic data came various information on domestic and from the WHO, authoritative media foreign case notification, travel platforms in China, such as CCTV News regulations and restrictions, clinical and People's Daily, and official websites of breakthrough cases and other epidemic health departments around the world. related information. Information was These sources guaranteed the authority updated in real-time, each marked with and the reliability of the data. release time and source. Information was broadcasted in a unified format, with bold The Epidemic Map provided information headlines and a brief summary below. A on domestic outbreak based on the actual link to the source was also provided, situation of the disease prevention and allowing readers to grasp the latest epidemic control information. There were information on the epidemic and have the six key information categories covered. option to view the quick updates or read These included cases from existing in depth. Based on the collective confirmed, cumulative confirmed, information available, readers were able to, imported, to existing asymptomatic, and continued to make informed travel or cumulative deaths, and cumulative cured. work and life decisions. Each case was noted clearly with the amount of increase or decrease compared The Epidemic Map module was divided with the day before, as well as the into two parts: China and the rest of the cumulative amounts based on regions. The world. The outbreak information and data statistical classification and display of on China came from the official channels these data could essentially meet the of Chinese National Health Commission, public's need for different aspects on the provincial and municipal Health epidemic. Based on the above six Commission, as well as local government categories of data, there was a map of the

Figure 6. Map of the epidemic in China on June 8, 2020 at 3pm

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domestic existing confirmed diagnoses For the epidemic data of key countries (excluding deaths and cures) and around the world, the platform set up cumulative confirmed diagnosed tracking four categories of data: current (including deaths and cures), with confirmed diagnosis, cumulative different colors indicating different confirmed diagnosis, cumulative deaths severity levels to facilitate the inter- and cumulative cured cases. Each noted provincial comparison and highlight the with the amount of increase or decrease key areas for prevention and control in the compared with the day before. The current and cumulative period. platform ranked the epidemic situations of key countries in descending order based In addition, the Epidemic Map also on their cumulative confirmed diagnosis, produced a domestic epidemic trend map and demonstrated their cumulative based on the six categories of data and confirmed diagnosis, cumulative deaths, newly confirmed diagnoses. The Epidemic and fatality rates. Corresponding trend Map compared the various data since the figures of newly confirmed diagnosis were onset of the outbreak, in a longitudinal and provided for the top eight key countries to time dimensional manner, clearly and intuitively present the epidemic visually displaying the progress of the development in those areas. Further, in epidemic as well as new issues arise. The order to help the users better visualize the visualization of these data not only outbreak development, comparing allowed the public to understand the prevention and control of the epidemic implication behind the epidemic data local and abroad, the platform produced a more accurately, but also laid a solid graph that compared the two. The graph foundation for the public to better included newly confirmed diagnosis, understand and accept the prevention and cumulative confirmed diagnosis, and control measures, policies, and regulations cumulative deaths on the global scale. released by the government, based on Each graph presented two curves, one for these data.

Figure 7. Domestic outbreak trends on June 8, 2020, at 3pm (National new imported cases, National cumulative imported cases, National diagnosed cases)

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Figure 8. Trends in new diagnosis in priority countries and trends in new diagnosis in global outbreaks on June 8, 2020 at 3pm

China and one for the rest of the world for dispelling, effectively expanding the scope easy comparative analysis. of rumor collection. Users could also view

[3.1.2] Rumor dispelling and self- authenticity of the information they need. protection, and Covid-19 knowledge modules Rumor Dispelling and Self-protection module organized the individual In order to effectively curb rumors related protection knowledge with strong to Covid-19 epidemic and disseminate timeliness and operability, under the scientifically correct knowledge on categories of "I want to Travel", "I am disease prevention and control to the staying at Home" and "Family with public, DXY Covid-19 Real-time Information Children". Different categories were Platform set up modules of Rumor marked with different colors, and the Dispelling and Protection, and Common content was presented in bold headlines Knowledge of Disease. Rumors Dispelling with links for in-depth reading, which was and Protection module invalidated rumors convenient for users to quickly search and one by one. Each invalidation was noted read. The Covid-19 Knowledge module was with the party responsible and the source mainly designed for Covid-19. Though its of proof to ensure credibility. The content content was not meant to be for timely of invalidations was published in a concise, updates comparing to the Self-protection direct and easy to understand manner. module, the Covid-19 Knowledge module There were also images available for offered more theoretical and rumor dispelling that can be easily comprehensive content. The Covid-19 forwarded to major social media platforms, Knowledge module provided authoritative such as WeChat and Weibo, covering more integrated information on Covid-19, people who can be informed. In addition, covering information such as Covid-19 users could use the "I want to Expose causes, pathology, self-examination, Rumors" function to participate in rumor prevention, and treatment. The

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establishment of these two modules was experiences offered lectures. The lectures intended to popularize the knowledge of were played and shared on the DXY official the Covid-19, dispel and eliminate rumors website or DXY app. The course consist-ed by providing informative and credible of a series of 30 lectures, which were information for the general public, and divided into seven chapters: Analysis of ultimately strengthen disease prevention imaging characteristics, diagnosis and and epidemic control. treatment plan for patients with severe conditions, diagnosis and treatment plan [3.2] DXY free public online course for for patients with mild conditions, Covid-19 diagnosis and treatment interpretation of guidelines for Covid-19, diagnosis and treatment plan for infected In order to strengthen the hospital population groups, clinical care focused treatment capacity of Covid-19 at all levels and self-protection against Covid-19, and across the country and meet the rapidly research and progress. As of March 19, increasing demand for trained medical 2020, a total of 72,440 medical personnel personnel, DXY quickly communicated participated in the DXY Free Online Public with the medical treatment team of the Course for Coronavirus Diagnosis and Shanghai Disease Prevention and Control Treatment. at the onset of the outbreak, offering training course. On February 8, 2020, [4] DISUCSSION utilizing its mature online course platform, DXY launched the free online public courses for Covid-19 Diagnosis and Treatment. During the Covid- - time Broadcast module assisted the The DXY Free Public Online Course for government in helping the public face the Covid-19 Diagnosis and Treatment focused epidemic with emotional stability, on four areas: diagnosis and treatment rationality, and caution. Moreover, through plan, frontline expert experience sharing, timely and authoritative information in-hospital protection, and latest research communication as well as tailored lectures, progress. Prof. Zhang Wenhong from DXY helped effectively addressed the Department of Infection of Huashan challenges of high demand for medical Hospital, Prof. Hu Bijie from personnel remote training in a short time. Hospital, Prof. Huang Yan from The key success factors are as follows: Department of Infec-tion of Xiangya Hospital, Dr. Xiong Zeng, Deputy Chief [4.1.1] High reputation as a professional Physician from Department of Imagining of medical platform Xiangya Hospital, Dr. Miao Xiaohui, Chief DXY is a professional and well-respected Medical Officer of Shanghai Yuanhe Internet medical platform in China. It Medical Group, and 27 other reputable possesses professional methods, experts and doctors with frontline clinical experience, technology and manpower to

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gather medical and health-related - information and conduct data processing. information communication method The strong abilities allow DXY to quickly build an information integration platform DXY Covid-19 Real-time Information and achieve efficient and accurate Platform was a highly integrated platform. information updates on a regularly basis to After fully considering the information needs of the public, the platform Also, due to its high reputation as a integrated epidemic data, information, professional medical platform, compared rumors, protection knowledge and other with other social media platforms, more relevant contents, and arranged them professional medical personnel and the based on priority. The intuitive and friendly public would choose DXY as a channel for interface design allowed users to quickly, information release and acquisition. accurately and conveniently obtain the information they needed on a single [4.1.2] Visual presentation of data and platform, which greatly simplified the information tedious acquisition of information on the user side and provided a good user Visual presentation of the Epidemic Map experience. integrated complex and diverse data and information in a continuous spatial and [4.1.4] New media matrix for information temporal dimension, which highlighted communication the implication of data and allowed the data to be more comparable, which - helped the public to further reflect problems and trends. Through these visual of the DXY Covid-19 Real-time Information images, users were able to clearly and Platform is its integrated use of four new intuitively draw scientific conclusions on media channels, WeChat, Weibo, App and epidemic development and effects of web pages. These four channels formed an prevention and control through various effective information communication horizontal and vertical analysis matrix. First, the four channels achieved a comparisons. With more accurate and in- wide coverage, which can basically cover depth understanding of the epidemic, most of the public and ensure that users users were less blindly optimistic or panic, can obtain information through the which was conducive to maintaining channel they are most familiar with. Since public emotional stability. Users can also the launch of the Real-time Information better understand and accept the relevant Platform, the official website has prevention and control measures accumulated more than 4 billion views, implemented by the government. In this with daily views up to 200 million, sense, visualization helped the covering a considerable range of users. implementation of unified prevention and Second, the four channels have their own control measures. advantages. Instead of simply positioning

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them as four different communicating explore the following necessary conditions ways with the same function, DXY utilized for replication: their respective strengths and allowed them to serve different purposes. While [4.2.1] Mature and professional platform the most basic and most important As one of the largest Internet health information was ensured to be correctly platforms in the industry, DXY has communicated, the main modules of each professional platform operation channel were differentiated. This way, the technologies and personnel, a mature effectiveness and efficiency of information functional system, a considerable number communication can be effectively of professional medical users, and a good improved while its accessibility, timeliness, reputation. Therefore, DXY has significant accuracy, and interactivity were advantages in data sharing and course guaranteed. publication and publicity when [4.1.5] Mature online education system collaborating with the government. Also, it has credibility and authority in conveying As a multi-functional integrated Platform, information and content to users, which in DXY itself has a mature online education turn can attract more users, increase the system, consisting of a website and App influence of the platform, and forming a for public classes. When new online virtuous circle. lectures needed to be posted, DXY did not require additional manpower, material [4.2.2] Wide coverage and high usage resources, and time to build a platform or rate of new media contract for cooperation. Instead, DXY can Whether it is the Covid-19 Real-time directly embed the lectures into its online Information Platform that covers four education system. In terms of media channels of information communicating with the government, communication, or the free online public courses for Covid-19 diagnosis and a guarantee for its efficient and effective treatment, the wide coverage and high operation. In terms of medical personnel utilization rate of new social media who were already users of DXY, they did platforms were the predominant reasons not need to refamiliarized with new the system succeeded. At present, new interface or functions, and thus saving social media sector is developing rapidly time and effort. in China, and the number, age, occupation, [4.2] Necessary conditions to replicate and social class of user groups are increasing day by day. It can be reasonably and optimistically predicted that while the DXY performed well in the two major tasks Covid-19 prevention and control will be a of information communication and normalized measure, using new social personnel training for the prevention and media platform to complete various control of the Covid-19 epidemic. We can information communication and personnel

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training in the medical field is highly collaboration between the government feasible. Meanwhile, however, it should and the enterprises can strengthen and also be cautioned that the acceptance of enhance solutions to support social and new social media platforms still varies public needs. across different regions and across age and occupation. Therefore, this tool requires further improvement to ensure 6.1 more timely and convenient access to new Case Study VI: Baidu Map social media platforms like Weibo and WeChat, so that the information can effectively reach wider people groups. ABOUT Baidu Map

[4.2.3] Good collaboration between Baidu is the largest Chinese search engine public and private sectors in the world. In 2005, Baidu launched its travel service platform Baidu Map, which DXY fully utilized its own advantages in aims to provide users with various services technology and platform maturity to including intelligent route planning, intelligent precise navigation, real-time information communication and medical road conditions, etc. Baidu Map is available personnel training. The premise of on mainstream operating platforms such achieving this goal was mutual trust and as the Web, PC, Android, and iOS. As a openness for collaboration. For example, representative of the most advanced in the case of the Covid-19 Real-time artificial intelligence map services, Baidu Information Platform, the government Map works with pioneering traffic data provided much data and information, collecting teams and equipment, enabling while DXY visualized the data and it to cover 209 countries and regions publicized them to the most extent. This around the world. way, the credibility of the government and the data processing technology and [1] BACKGROUND: Timely and Accurate communication technology of DXY were Population Flow Data Can Help the perfectly integrated. Another example, in Public Make Safe and Informed Travel the case of the free public online course, Decisions the government communicated with medical experts to record the lectures, Covid-19 is highly transmissible and and DXY gathered the targeted audience spreads at an accelerating speed. and launched the lectures on its online Therefore, avoiding human interactions as education Platform. In this sense, the much as possible is the predominant cohesion and overall coordination ability measure to prevent large-scale spread of of the government and the user the epidemic. As a result, in addition to the management and business functions of number of confirmed cases and the DXY were well combined. Good growing infection rate, the population flow data of a place,

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such as flow direction, flow rate, and concise enough. With misleading and aggregation level, are also important references for the public to make safe risk of infection increased. This remained a travel decisions. In terms of disease problem from the provincial level, down to prevention and control, avoiding gathering town and local village level. Information and a large-scale influx of people into misalignment increased the difficulty in high-risk areas are important measures to implementing effective disease prevention cut off the infection chain. Since it is and control measures. There were two impossible for the government to provide main problems: precise travel guidance for every individual, it is particularly important to ensure that [2.1] Text announcements of "Travel individuals can make the safest and the History of Confirmed Covid-19 Cases" most informed travel decision on their own. lacked visual presentation This is also one of the key points for The official post of the Covid-19 cases sustainably carrying out disease usually contained information such as the prevention and control in an epidemic origin of the case, the nature of the case, outbreak. Offering population flow data and travel history. However, the posts are and travel suggestions to the public is an presented in texts format, without any indispensable assurance method to visual information of any key landmarks or achieve the above goals. Timely and environment information to help people accurate population flow data can easily locate and mentally capture the effectively help the public combat the information. Yet during the outbreak, it is epidemic wisely while still maintaining a especially important for announcements relatively normal lifestyle. This information to grab attention as the amount of public can also facilitate the public to effectively information is already overwhelming and understand and use the information on the confusing. If the public wanted to avoid epidemic released by the government to high-risk locations when traveling, they dampen the panic and fear. would need to conduct much research [2] CHALLENGE: Lack of Objective and and pre-travel planning. For those who are Accurate Population Flow Data travelling to unfamiliar regions, following guidance in a text format proved neither Upon confirming that Covid-19 is highly timely nor effective. transmissible, the government fully publicized, via various communications [2.2] Insufficient information on channels, the importance of avoiding locations with high population density crowd gatherings and travelling to high Besides the high-risk locations visited by risk areas. However, the detailed confirmed cases, commercial districts, information on which specific locations hospitals, transportation hubs, and other had crowd gatherings or where were high places were also high in population density, risk areas was not objective, clear, and

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and therefore were potential locations for Control and Prevention Center released large-scale transmission. However, the information on previous locations of real-time population tracing in such areas confirmed Covid-19 cases for the first time. can change radically. As a result, without an authoritative platform supported by a History of Confirmed Covid- huge data system to collect, filter, process, -19 and post relevant information, it was difficult for the public to obtain timely and accurate population distribution and gathering information to mitigate the spread.

[3] SOLUTION: Baidu Map Visualized Population Flow and Distribution

In response to the two major challenges mentioned above, Baidu Map develop-ed maps and layers specifically for Covid-19. Utilizing its own leading artificial intelligence technology, Baidu Map provided the public with timely, accurate, and easily comprehensible population flow information through visualization methods such as color separation and layering. It

Confirmed Covid- layer for all maps. According to statistics, by the end of March 5, 2020, Baidu's epidemic travel aggregation page had accumulated a total of 50 million inquiries, the epidemic community information provided had covered 261 cities and tens of thousands of specific epidemic sites across the country, and users have Figure 9. Covid-19 activity map, with conduced searches via the platform over labelled locations with Covid-19 cases 100 million times .

- country, including Beijing, Zhongshan, , and Guangzhou. The high-risk locations were marked on the map with a On February 6, 2020, Beijing Disease red virus-like logos. Within a week, Baidu

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Figure 10. Covid-19 activity map search result sample

Map completed labelling all locations with Global Positioning System (GPS) function, traces of Covid-19 cases. The Covid-19 Baidu Map would also have navigation Activity Map can timely provide the public prompts to remind user(s) whether that with updated case information and assist location was a high-risk area. The functions the communities to carry out precise on Baidu Map provided timely and disease prevention and control, helping to accurate information to help residents or further reduce the pace and scale of travelers make informed travel decisions. spread.

The Covid-19 Activity Map can be "Heat Map" layer accessed via web and Baidu Map app, both are easy to operate and maneuver. If "Baidu Map Chinese New Year Population there was a need to check whether there Migration Big Data" (hereinafter referred to had been confirmed cases in the desired destination(s) or proximity, users can also data visualization project for "population directly enter the destination(s) in the migration" launched by Baidu. It conducts search box. If there were cases in the migration analysis through massive Baidu location, the system would post a notice in Map navigation big data, which is also an red, stating "This place was visited by important function of the Baidu Map individuals confirmed with Covid-19". In Intelligence Project. The outbreak of the addition, if an individual were to use the Covid-19 coincided with the 2020 Chinese

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Figure 11. Baidu migration map page view sample

New Year, the biggest human migration distinguish between immigration and period each year. To facilitate the targeted emigration. This was used to infer the and comprehensive disease prevention degrees of population flow across different and control by providing the referential road sections. Users can also select cross-provincial population flow data, specific provinces or cities to view the rankings and the travel intensity within the January 10, 2020, and later extended its selected region. The information helped access timeline. On May 8, 2020, Baidu users make rational decisions on their Migration Map officially stopped its data destinations, routes selection, and travel updates. methods. popular immigration (emigration) regions nationwide using red (blue) circular users visual information on population gatherings at the city/district level. The "Heat Map" layer used different colors and concentration level of people at the coverage sizes to reflect the degree and provincial/municipal level. The Map also scale of population gathering: when the directly provided rankings of the cities, color has more yellow and orange tones, based on their immigration (emigration) the higher the Heat and the higher the flow. In addition, the Map provided a degree of population gathering; when the migration scale index that did not color has more blue and purple tones, the

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lower the Heat and the lower the degree of population gathering. The "Heat Map" layer was updated with real-time data, which provided users with timely information and enabled them to avoid high heat and high transmission risk areas.

[4] DISUCSSION

The maps and layers provided by Baidu Map, presenting population flow information, offering objective, accurate and timely population flow data, with effective visual presentation. The Map provided the public with ways to make informed travel decisions, avoiding high risk locations and crowds. The high public usage and inquiry rate also proved the practicality and effectiveness of these factors are as follow:

[4.1.1] Superior artificial intelligence and big data technology

Baidu Map is a leader in the map service industry, and its core strength is the artificial intelligence and big data technology used for data collection and Figure 12. processing. Presently, 80% of Baidu map sample data collection is realized by artificial intelligence. During the Covid-19 outbreak, crowd aggregation, with precision down when on-site data collection was largely to a street level. The advanced technology restricted, artificial intelligence showed its makes it difficult for other platforms to incomparable value. In the case of the leading the population migration map market. artificial intelligence technology that made it possible to collect both cross-provincial [4.1.2] Great integration of existing population flow information and real-time services and modules

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On the day Beijing released the locations As one of the most used map services in and travel paths of the confirmed Covid-19 China, Baidu Map is widely used and highly cases, Baidu Map responded rapidly and trusted because it is accurate, fast, and launched the Covid-19 Activity Map for 49 has a wide coverage. The number of users cities same day evening. The rapid of its intelligent voice navigation function response successfully channeled many alone has exceeded 300 million in 2015. Its people who were concerned about the number of monthly active users steadily ranks as top two in the country. As of 2020, service. The ability to integrate existing the mobile user penetration rate of Baidu services and modules was a major reason Map has exceeded 70%, and the number is Baidu Map was able to provide several still increasing. The massive user volume services within a short period of time. provides abundant flow of data for Baidu Although the Covid-19 Activity Map was a Map, which became the basis for the map service newly set up for the epidemic, solutions like location labelling and information insertion were modules Baidu the user volume ensured the high usage Map had already been utilizing. Thus, rate after the launch of new services, Baidu Map was able to quickly add forming a reinforcing and positive cycle. relevant information to the map. Similarly, although the "Heat Map" layer was a brand- [4.2] Necessary conditions to replicate new service content, based on the previous experience of layer design, it flow mapping service is mainly due to the to add the "Heat Map" layer to the existing above factors. If other countries and map. The users were able to use this regions would like to launch a similar function easily. project, the following two necessary "Baidu Migration Map" is a service that is conditions are required: normally launched during the Chinese [4.2.1] Mature application of artificial New Year Festival each year. This year, intelligence and big data technology Baidu Map extended its availability to support disease prevention and control, Artificial intelligence and big data offering a big data service that the public technology are not just the key to Baidu was in dire need. Great integration of Map's successful population flow mapping existing services and modules not only service, but rather the decisive factor of its successfully channeled many Baidu Map pioneering position in the domestic users to its new functions, but also rapidly mapping industry. Artificial intelligence and sustainably provided users with the and big data technology is at the forefront services at nominal cost to the company. of the development of the digital technology industry, and this technology [4.1.3] Baidu Map has many users and became indispensable during the Covid-19 has gained public trust

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epidemic. Without the support and empowerment of artificial intelligence and big data technology, such a large-scale, internet services providers. Tencent offers timely, and accurate population flow map a wide variety of services, ranging from would be difficult to achieve. However, the social and communication services, social development and maturity of the artificial networking platforms, games, and website intelligence and big data technology takes development, to news media, online video time. Therefore, companies should services, and healthcare related solutions. prioritize the research and development of the technology and build its capability, so [1] BACKGROUND: The Importance of that when there are unexpected situations Timely Medical Information and Non- or crisis, the technology can be a strong profit Organization (NPO) Management support. During the Outbreak

[4.2.2] Significant amount of user data During the Covid-19 outbreak, it was important for suspected or probable Baidu Map is one of the most used service Covid-19 patients to receive timely platforms in the Chinese smart mapping updates on medical institutions-related service industry. Massive user data volume information, such as locations of fever makes it possible for artificial intelligence clinics or the capacity of nearby hospitals. to analyze and develop the flow map. A Many suspected or probably patients large number of Baidu map users provide would panic as Covid-19 like symptoms abundant mobility data, which is then arise and rushed to nearby hospitals, used by Baidu Map to process and which overwhelmed the institutions or produce an intuitive and understandable clinics and further increased the risk of population flow map to help users make transmission and the spread of the virus. travel decisions. The more users are using There was thus an urgent need for a the Map, the more data collected. To centralized platform to publish timely replicate the Baidu Map solution, updates with medical institution related companies would need to occupy a large information for the public. enough market share in order to accumulate a significant amount of user It was also critical for hospitals to receive data. donations during the pandemic as resources were depleting at an accelerating rate, as the Covid-19 outbreak 6.4 unraveled very rapidly in China. Hospitals quickly ran out of medical supplies and Case Study VII: Tencent resources, and many hospitals began to seek donations from the public. ABOUT Tencent Companies and individuals across the Shenzhen Tencent Computer System Co., country began to fundraise and call for supply donations via social media and

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crowdfunding platforms. In China, only [2.1.2] Long waiting lines in hospitals qualified public funds are legally allowed risks cross infection to raise money from the public in China. However, many organizations fundraised As a respiratory infectious disease, Covid- with insufficient qualifications, which 19 can be transmitted via respiratory greatly affected the efficiency of droplets. During the outbreak, an donations and resources allocation. Under overwhelming amount of patients with these circumstances, a centralized various diseases, including suspected platform that integrated philanthropic Covid-19 patients gathered in designated information and facilitated donations clinics and hospitals. Close contacts in management became an important hospital crowds and long waiting lines component in bringing hospitals, donors, created more opportunities for infection and NPOs together. transmissions.

[2] CHALLENGE: Hospital Information [2.2] Fundraising organizations lacked was Difficult to Synchronize and NPOs management and supervision Lacked Management [2.2.1] Varying quality of fundraising [2.1] Hospital information was difficult to organizations and lacking in reliable synchronize donations channel

[2.1.1] Suspected Covid-19 patients In the early stages of the Covid-19 lacked information on which hospital to visit Protective Equipment (PPE) and other medical equipment quickly became During the Covid- limited, and they turned to the public to National Health Commission (NHC) ask for donations. Many fundraising designated specific fever clinics and organizations emerged during this time, hospitals to receive Covid-19 patients in but most of them were on social media order to reduce risk of cross infection in platforms, and many were unverified the hospitals. When suspected patients organizations. The extend of the fund- observed symptoms, they would ideally raising information that these visit specified Covid-19 hospitals and organizations created often misled clinics instead of rushing to any hospitals potential donors, with some, unfortunately, nearby. However, the information on which deemed fraudulent. In addition, the hospitals were available for Covid-19 fundraising information available were diagnosis and treatment, as well as the scattered across different social media platforms, which made it difficult for the led suspected patients to visit hospitals public to acquire sufficient and randomly, which further reduced the trustworthy information. Donors thus efficiency of disease control and lacked a reliable channel to support front prevention efforts. line medical personnel.

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[2.2.2] Unsupervised fundraising programs, and public accounts detailed organizations fail to publish financial manuals on how to embed or connect information their respective platforms. As most fundraising organizations emerged during this period were mostly [3.1.1] Application gathers official unsupervised and lacked proper internal hospital information and automatically management, many failed to publish matches patients to the nearest fever financial information after they raised clinics funds. Important information such as whether the funds raised were used as On January 27, Tencent Health launched promised, how the funds were used, and the "Covid-19 Designated Hospital and how individual and organizational donors Fever Clinic Guidance Platform" could file feedback were often unavailable. Many times, donors even had to personally call these organizations to inquire about Platform is a mini program within WeChat the funds. There was a strong demand and that allowed users to look up designated need for a reliable channel to supervise Covid-19 fever clinics and hospitals, either the management of funds raised and the in a list view or in a map view. With the list resources collected. view, the application generates a list of designated Covid-19 hospitals and fever [3] SOLUTION: Tencent Health Platform clinics, ranked by distance to the user. and Tencent Charity With the map view, users are able to view hospitals around them with visual [3.1] Covid-19 map on the Tencent health reference to the locations. Users can platform access the application by simply searching - Tencent Health is a digital health platform WeChat. By February 4, 2020, The Platform covered 357 cities across China, with over (AI), cloud computing, security, and digital 12,000 hospitals, of which 11,637 were payment technologies. In order to address fever clinics and 1,960 were hospitals. the need for a centralized hospital relevant information, Tencent Health developed a [3.1.2] Real-time hospital traffic data - reduces hospital crowds purpose messaging, social media and mobile payment app platform with the Knowing that waiting time at fever clinics largest user- and hospitals was long and can increase information on where to find the the risk of cross infection, Tencent Health designated hospitals and fever clinics. The upgraded The Platform one week after its mini program allowed users to look up launching to include a hospital traffic hospital traffic. Further, Tencent Health function. Users were then able to schedule also provided other applications, mini their own hospital and clinic appointments

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Figure 14. -Time Traffic Announcement and Consultation Guidance Page based on the real-time hospital traffic. individuals, private organizations, and Hospital traffic data were updated by public fundraising organizations can use to hospitals them-selves and categorized into start fundraisers. Projects initiated by three metrics: normal, more crowded than individuals and private organizations normal, and less crowded than normal. needed to be adopted by public Take the Guangdong Maternal and Child fundraising organizations. Once Tencent Health Hospital for example, users were Charity reviewed and approved the public organizations, they could begin from the map interface and view the fundraising on The Platform. During the Covid-19 outbreak, Tencent Charity also (Figure 14). Hospitals also published initiated a fund-raising project where users information such as which departments were randomly selected to send were open, as well as other guidelines for encouraging messages to frontline patients. medical personnel. Until February 22, 2020, around 6.5 million people had participated [3.2] Tencent charity managed fund- in this initiative. raising organizations

Tencent Charity is an open platform where

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[3.2.1] The platform conducted quality and 126 projects fund-raise online. More control, project management and than 11.5 million people donated via publishing for fundraisers Tencent Charity, with donations exceeding RMB56.7 million. In face of the rising number of fund-raising organizations emerged during the Covid- [4] DICSUSSION 19 outbreak, Tencent Charity conducted stringent reviews on these organizations before allowing them to fundraise on [4.1.1] Disseminate information through WeChat included asking the organizations to register with real names, uploading their qualification certificates, submitting one of the most widely used social media project introductions, budget, execution platforms in China, with over 1.1 billion plan, as well as other proof of the users recorded at the end of 2019. review and approval process, public information on the platform to easily reach organizations were able to begin most citizens. Tencent also added a fundraising directly on the platform. Individuals and private organizations had interface during the outbreak so that users to apply their projects to the approved can easily access health information and public organizations and ask for their services. adoption. Tencent Charity allowed fundraising organizations to reach more [4.1.2] Collaboration with the donors and provided the donors an easily government to incorporate official accessible and reliable donation channel. information

[3.2.2] The platform allowed for public When providing information on designated supervision hospitals and fever clinics, Tencent collaborated with the NHC to publish the Tencent Charity, by requiring organizations to publish project execution details, hospitals were designated for Covid-19 allowed the donors and the public to patients on The Platform. This ensured that supervise the progress of their projects. suspected patients were receiving the The donors and the public can easily latest and most reliable information on monitor whether the funds were properly how to seek treatment and diagnosis. used and report feedback to Tencent [4.1.3] A reliable and renowned suspicious of the usage. One month after philanthropic platform Covid-19 broke out in China, Tencent Tencent Charity was established in 2007 Charity supported more than 90 charities and had garnered sufficient public

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recognition and trust by the time Covid-19 to incorporate official data onto its broke out. Tencent Charity was able to Platform directly. establish public trust by hiring certified third-party auditor every year to review its [4.2.3] A charity platform with high accounts, which were then published on public trust Public trust is a critical factor for fund- review. Tencent Charity also regularly raising efforts to succeed. Therefore, a monitors and follows up with fundraisers reliable and credible charity platform is on its platform, maintaining close needed to ensure that fundraising communications with its members. organizations are operating legally, at the [4.2] Necessary conditions to replicate same time, to maximize the amount Tencent's solutions received. During the outbreak, an existing charity platform with sufficient public [4.2.1] A communications platform easily credibility should step forward and accessible to the public shoulder the responsibility in pushing forward emergency fundraising projects. philanthropic projects relied on a countrywide social media platform to 6.5 reach their audience. An application or platform similar in reach to WeChat will Case Study VIII: Beijing help maximize the audience reached and Viewhigh Technology reduce the cost of launching projects. If such a platform is not available, one can ABOUT Beijing Viewhigh Technology also consider using phone calls or television broadcasting to communicate Viewhigh Technology (originally known as relevant information and services to the Dong Ruan Wang Hai) was founded in public. 2003 and has since then dedicated to optimize information technologies and [4.2.2] Reliable information sources digitalized operations. Viewhigh constantly In terms of providing hospital information, explores and innovates in domains Tencent launched its project at a time including Hospital Resources Planning when most citizens were overwhelmed (HRP), hospital costs unification, Diagnosis with the amount of mix of information Related Group (DRG), auto payment and related to Covid-19, much of which were auditing, smart financing, smart logistics, inaccurate and misinterpreted. The holistic man-power, performance developer of an information platform incentives, and healthcare resources would thus need to obtain reliable management. Currently, Viewhigh has over information sources, similar to how 3,000 healthcare system partners, with Tencent collaborated with the government 800 tertiary

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hospital partners, over hundreds of including manufacturing plants. As a result, contractual partnerships with municipal during the outbreak, medical supplies Health Commissions and Human became even more scarce as many Resources and Social Security Bureaus, hospitals were unable to secure more and over 40,000 supply chain partners. resources through their regular purchasing systems. Many frontline designated Covid- [1] BACKGROUND: Hospital Emergency 19 hospitals in Wuhan City had issued Resources Management Platform announcements to seek donations online. Resolved the Hospital Resources Though the announcement attracted Shortage Crisis massive amount of donations from factories and individuals, the hospitals Supply chain management is a key lacked emergency resource management element in hospital operations. Resource systems to handle the abrupt abundance provision is one of the most important of donations. Hospitals also lacked elements in medical institutions and health medical personnel to assess the suppliers administration departments, especially in and the supplies. Furthermore, many times of crises. These difficult times bring donors and suppliers were not on the challenges to the sustainability of supply existing approved list of suppliers for the chain management and operations. hospitals. Therefore, even though there Hospital emergency resource was abundance in donations from various sources, the hospitals lacked efficient operations. On one hand, the platform management process to help properly allows the hospitals to place urgent orders receive and manage the supplies. with suppliers or accept available donations via the platform. On the other [3] SOLUTION: Hospital hand, it offers a channel for the general Emergency Resources Management public, including corporations and Platform individuals, to donate to designated medical institutions via the platform. The In the onset Covid-19 outbreak, Viewhigh platform then promptly reports back the leveraged its existing technology solutions relevant donations information to the and launched the Hospital Emergency medical institutions, allowing for more Resources Management Platform efficient supplies management. (hereinafter referred to as the Platform) within four days of development. The [2] CHALLENGE: Information Mismatch Platform launched on February 3, 2020. Between the Shortage of Medical The goal of the Platform was to establish a Resources and Abundant Donations communication channel between Received from the Public suppliers and hospitals. The Platform addressed the needs of the hospitals, and The Covid-19 outbreak coincided with the provided a comprehensive resources Chinese New Year, during which management system via three aspects: businesses were closed for holidays,

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organized connection between suppliers For the hospitals that still faced shortage in and hospitals, efficient selection of resources, Viewhigh broadcasted resources and donations, and emergency resources requests to online management of donated resources post medical supplier communities to help find arrival at the hospital. procurement standards. Once there is a The Platform connected suppliers and match, Viewhigh would assess the quality hospitals, and provided key support in two of the suppliers for the hospitals before areas: online donations and emergency connecting the two sides. Once the procurements. The platform published supplies reached the hospitals, the real-time donation requests and Platform streamlined the existing hospital emergency procurements online to over logistics workflow and established a new 40,000 suppliers. Simultaneously, donors system, allowing procurement and suppliers could input donations and management, logistics coordination, relevant information including inventory management, and real-time qualification certificates, such as product reporting. With real-time inventory registration certificate, business license, management and tracing, such as real- and production license, for hospital to time supplies monitoring of the ins and assess whether to receive the supplies or outs and real-time statistical data, the donations. The platform also provided supplies were precisely and efficiently hospitals with single button enquires to managed during the outbreak. During the the supplier to search for resources time of Covid-19 crisis, this Platform efficiently. Many hospitals on the frontline solution not only helped hospitals and combating the outbreak, such as Wuhan suppliers meet all the national audit Jing Yin Tan Hospital, registered on the requirements, but also drastically Platform to issue requests for resources. alleviated the workload for medical Some hospitals were able to receive the personnel, and met the demand for resources they need via the Platform. As efficient medical supplies management. there was much data collected on this Platform, data from the hospitals, the Since its launch, in addition to Wuhan Jing donors and suppliers, strong Yin Tan Hospital, Wuhan Central Hospital, backend technology ensured to not only and Wuhan Leishenshan Modular Hospital, provide stable and secured operations, but hundreds of hospitals and medical most importantly, to ensure data security. institutions registered on the Platform and sent out requests for resources. On March To reduce the time and effort spent by the 25, 2020, Wuhan reopened its city, the hospitals in assessing the supplies from Platform had over 170 hospitals registered, the suppliers or donors, View- with over 25 charitable organizations and operation team pre-screened the suppliers corporations offering support, realizing to ensure the quality of the donations RMB 7.6 million in donations. It is also meet the hospital procurement standards. important to mention that the Platform

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was established by Viewhigh specifically [4.1.2] Close relationships and trust for the medical institutions to connect between hospitals and Viewhigh them with suppliers at no costs to the institutions. Viewhigh has established long term partnerships with many hospitals in China [4] DISUCSSION prior to the Covid-19 outbreak. As a result, when the Platform officially launched, [4.1] key success factors close to 170 hospitals immediately registered on the Platform. This Platform ability to rapidly design and served as a crucial means to secure launch the Hospital Emergency Resources medical resources to many frontline Management Platform was based on its hospitals, including Wuhan Jing Yin Tan digitalization of information and resources. Hospital, Wuhan Leishenshan Modular With its strong technological foundation, Hospital, First Affiliated Hospital of Viewhigh provided a strong channel and Medical University, Qiannan technical support to facilitate information People's Hospital, Xinhui People's Hospital exchange between both the supply and in Guangdong Province, Chaoyang Central demand of emergency supplies. In Hospital in Province. The addition, the Platform was able to conduct relationship and trust between Viewhigh real time resources tracking for the and the hospitals was the catalytic factor hospitals to ensure efficient management. for the Platform to build traction and The key to success is as follow: become fully quickly utilized. [4.1.1] rich resources and [4.1.3] Quality control and assurance of information reserve suppliers and the donated supplies The Hospital Emergency Resources During the outbreak, frontline hospitals Platform took merely four days to build, were overwhelmed with Covid-19 patients, from design to launch. Within the few days, with no medical personnel to spare to Viewhigh established a team, developed assess suppliers and the donated backend support, and conducted data resources. Aware of this challenge, with cleaning. The highly efficient workflow the guidance from the National Medical was cultivated through its focus on Products Administration, Viewhigh hospital system management, especially in decided to help. Utilizing its existing research and development, which technology and channel partners, provided in-depth understanding of the Viewhigh was able to support the hospitals needs and challenges faced by hospitals. by screening the suppliers to ensure their Therefore, Viewhigh was able to provide qualifications, assess the donations from various sources to ensure the donated during the outbreak. goods were up to hospital standards. This greatly reduced the hospitals risks of

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acquiring unsuitable resources, thereby [4.2.3] Financial support increasing operational efficiency. The Hospital Emergency Resources [4.2] Necessary conditions to replicate Platform was built by Viewhigh, com- solution mitted its own resources to provide solutions for its partners. The price and The aforementioned factors are conducive agreements on the Platform were decided to success in its resource by the suppliers and hospitals. Without management platform. However, in order sufficient capital investment and personnel to replicate solution in other commitment, this Platform would not be in countries or regions, the following function for an extended period of time. elements are essential to recreate the Therefore, committed financial support Platform: and technical team support are important factors to continuously maintain the [4.2.1] Cloud platform support Platform. The Viewhigh Hospital Emergency Resources Platform was built based on its Viewhigh Cloud. During Covid-19 outbreak, 6.6 the Cloud provided fundamental support to the overall hospital Case Study IX: IZhaohu management platform. It encompasses four major technologies as its framework, ABOUT IZhaohu mainly mobility, cloud computing, internet of things, and big data. These technologies Shanghai IZhaohu (IZhaohu), is the first make the foundation for the hospital platform in China that integrated emergency resources management knowledge, Internet of Thing (IoT), Big platform. Data, and Artificial Intelligence (AI) to provide smart personalized eldercare [4.2.2] Clear understand of collaborating services. IZhaohu was founded in 2007 and has since then invested significantly in research and development to enhance IoT Viewhigh has built its reputation in hospital technologies in ageing related industries. management industry and has established In order to provide targeted services for long term collaborative relationships with the different needs of the elderly in many hospitals. Further, during the different life cycles, IZhaohu leveraged the outbreak, resources in hospitals were power of AI and big data to digitalize and rapidly depleting, at a rate faster than they mobilize elderly services and healthcare can be replaced. Upon learning this, related resources. Viewhigh was able to quickly develop a comprehensive and tailored resource management tool for its hospital partners to seek support for the public.

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[1] BACKGROUND: Information and protect susceptible population groups. Communication Technology (ICT) This section analyses these three Enabled Remote Health Management in challenges in detail. the Elderly Population During the Covid- 19 Outbreak [2.1] Contacts between caregivers in eldercare facilities are unavoidable, and - eliminating routes of transmission is 19 Emergency Response Group difficult Epidemiological Team has published the -CoV-2 Pneumonia Epidemiological Covid-19 has a relatively long incubation period, and thus it is needed to contain the the mortality cases. The study specified source of infection and eradicate all that the related cases and mortalities of possible routes of transmissions as soon as SARS-CoV-2, hereafter Covid-19, tended to possible. During the outbreak, many occur in patients who were older in age, eldercare institutions employed a closed and was more common in the elderly management system and conducted population with majority of cases over 60 contactless eldercare in order to minimize years old. It was also more prevalent in contacts between elderly in long-term care patients with chronic diseases. Therefore, and people out of the institutions. the elderly health management was of However, actual implementations were utmost importance during the Covid-19 difficult. For instance, during supplies or outbreak. Under these circumstances, medications deliveries, elderlies in long- leveraging ICT including internet and AI term care would still come into contacts enabled remote health management with others. through digital sensors, machine-assisted [2.2] Difficulties in systematically identifications, and data predictions, monitor body temperatures for multiple which can minimize the risk of contact groups of people, and inability to detect trans-mission between caregivers and the symptoms other than fever elderlies while still maintaining quality care. During the Covid-19 epidemic, temperature and symptoms screening and [2] CHALLENGE: The Three Main monitoring are some of the most Challenges in Managing Infection Trans- important measures. As many eldercare mission Risks institutions have insufficient experience in Based on the characteristics of infectious outbreak response, they were unable to diseases, the management of Covid-19 implement and monitor measures such as infection transmission risk among elderly temperature screening for the elderlies population can be divided into three parts: and caregivers, symptoms screening, data eliminate routes of transmission, screen auditing, and data storage. It was also and monitor the source of infection, and difficult to obtain body temperature and movement records of the visitors.

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[2.3] Insufficient support for the knowledge on infection control, dis- caregivers, the elderlies and their infection and other related topics. There families was a need for professional training and management in these areas. However, [2.3.1] Difficult to fulfil needs of elderlies, conventional face-to-face teaching and leading to increased anxiety management was undesirable for outbreak control and increased management costs. Due to the underlying chronic diseases and deterioration of health with age, elderlies face progressive decline in eldercare is insufficient and profession- cognition and mobility, and thus they nal training is much needed increasingly require support from care- givers. However, with travel restriction and Since Covid-19 outbreak occurred during strict disease prevention and control the Chinese New Year, many elderlies went measures during the Covid-19 outbreak, home with their families to celebrate the relatives and caregivers were unable to visit elderlies at the eldercare institutions. spread. Subsequently, the elderlies were For the elders living alone, they were unable to return to the eldercare unable to receive timely at-home care and institutions as the outbreak worsened. living support. In addition, many Therefore, the family members became caregivers were unable to return to eldercare institutions in time because of members often have insufficient travel restriction and social distancing knowledge and training to care for their measures, leaving many elderlies having elderlies, and therefore unable to provide insufficient care during the onset of the the care the elderlies need. outbreak. At the same time, due to travel restrictions and the need to minimize the [3] SOLUTION: Digital Solution risk of trans-missions, many elderlies living IZhaohu is a care provider that highly at the institutions were unable to see their leverages digital technologies, such as families for an extended period of time. sensors and apps, to provide care for its This has brought on stronger burdening residents. The company invented two emotions, such as anxiety and stress. digital management system: a remote [2.3.2] Employee knowledge in disease monitoring system, called Cheetah, and a prevention and control is insufficient, smart system, called Dolphin. The Cheetah and traditional teaching and is comprised of a client-facing and an management methods need employee-facing port, linking the families improvement and the caregivers via their respective user-app. With a large number of sensors The educational background of the installed in its facilities, IZhaohu can pick employees in eldercare institutions varies. up any activities inside the institutions and Some employees had insufficient

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notify the systems. The Dolphin is an IZhaohu mandated temperature and internal management system within symptom screening for all the elderlies in IZhaohu, mainly for employee its care facilities. To ensure the caregivers management, client management, and risk are following Covid-19 management. During the Covid-19 guidelines, such as temperature taking, IZhaohu used smart cameras to monitor able to minimize transmission by temperature check, caregivers need to eliminating contact, screen and monitor upload the data to the Dolphin system, the potential infection cases, protecting those system would then produce graphs of with high risk of infection. body temperature and verify the authenticity of the temperature data [3.1] Automated access control system collected. In addition, IZhaohu smart will interrupt transmission chains cameras were able to detect whether elderlies have cold-like symptoms, and Automated access control system had create warnings based on the data already been in place in some of the received. IZhaohu also required its eldercare institutions prior to the caregivers to monitor their own body Covid-19 outbreak. During the spread, in temperatures and upload a photo to the order to minimize risk of transmission, employee app on a daily basis. Family IZhaohu took stringent measures, members who wish to visit the elderlies expanded the usage of automated access would need to upload their temperature control system, and opted for centralized and photo daily for 14 consecutive days in management. Family members of the advance of their intended visit and provide elderlies no longer had access to satellite travel histories to online survey. care facilities. Everything was centrally monitored and managed. Automated [3.3] Providing protection and support smart surveillance was used to monitor for the caregivers, the elderlies and their care facilities, using face recognition to families manage and track employees. The smart surveillance could also track whether the [3.3.1] Cheetah remote monitoring employees were wearing protective gears, system and smart devices helped whether the entrances were closed protected the elderlies at home properly, and whether no-contact purchasing, and supplies collection were For families with elderlies at home a-lone, being conducted. IZhaohu offered home care services and technology solutions. IZhaohu utilized [3.2] Camera surveillance and cheetah remote monitoring system can daily movements, such as getting out of cooperate in detecting the source of bed, falls, and vital signs, and send timely infection updates to the family members. Sensors

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and remote monitoring systems can be elderlies at the eldercare institutions, simultaneously used to help family IZhaohu caregivers scheduled regular members become actively aware of the WeChat video conference calls between the elderlies and their families, in the hope IZhaohu also provided the elderlies with to help alleviate some anxiety and stress, smart beds. Smart beds utilize artificial as well as keeping the family feel intelligence (AI) technology and speech connected with one another. If necessary, recognition technology, allowing the IZhaohu can also connect the elderlies elderlies to control their beds using with counsellors for emotional counselling. simple voice commands. This decreased the need for physical contacts between [3.3.2] Dolphin smart system aided caregivers and the elderlies. In addition, IZhaohu employees with disease IZhaohu created a single button alarm prevention and control measures solution, which allows elderlies to call for IZhaohu employees and caregivers had help in emergency situations. If the button minimal knowledge and training in disease is pressed, the system not only sends the prevention and control. With Covid-19 alert to the family members, but also to outbreak, IZhaohu needed to provide IZhaohu and emergency services. training and knowledge support for its In addition to the services and solutions employees remotely. Dolphin described above for the elderlies at home, smart system served as a Platform to IZhaohu also provided non-emergency provide training on disease prevention and teleconsultations with doctors from top- control, as well as to regularly assess tiered medical hospitals. This helped learning progress. IZhaohu also utilized its reduced hospital visits, hence reducing surveillance system to ensure the the risk of infection and transmission. prevention and control measures were Moreover, IZhaohu adopted contactless property implemented. In addition, to help medication dispensing system by setting up a user app linked with individualized Dolphin smart system to arrange employee smart pill boxes. Family members can shift schedules efficiently. [3.3.3] Video conferencing to educate pill box to order and deposit the proper family members medication into the box. Izhaohu employees would then disinfect the smart IZhaohu used remote eldercare robots pill box and deliver the medication to the with smart screens and speech recognition specific elderly. In addition, IZhaohu functions to educate family members at deployed robots with sensors and data home on specific care techniques via collection functions to provide video conferencing. IZhaohu also regularly personalized care and rehabilitation scheduled WeChat video conferences with support for the elderlies. Lastly, with travel family members to provide professional restrictions during the outbreak, for the support and eldercare training.

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[4] DISUCSSION experience, and they developed a holistic management plan at the early stage of [4.1] key success factors Covid-19. This provided guidance in the During the Covid-19 outbreak, IZhaohu at various levels and ensured zero used information and communication infection within all the IZhaohu eldercare technologies to rapidly minimize and institutions. eliminate risks of transmission, through population group monitoring and [4.1.3] Multi-source income relieved screening, and provided remote eldercare cashflow shortage services and training. These had crucial significance in reducing risks of infection During the Covid-19 crisis, many and transmission, and ultimately helped businesses were greatly affected. IZhaohu protected the elderlies, their family also faced serious cashflow liquidity members, and the caregivers. The keys to challenges during the outbreak. In order to success are listed below: relieve the liquidity challenge and maintain in operations, as well as ensure their [4.1.1] Wealth of technology reserve systems and remote ICT technologies are functioning normally, many IZhaohu IZhaohu invests 15 to 20 million RMB on employees voluntarily reduced their research and development annually and has extensive experiences in working with minimum wage level. This act was not only technologies such as IoT, AI, and big data. At the early onset of Covid-19, IZhaohu to ensure the elderlies at their institutions quickly finetuned and adjusted their were taken care of. At the same time, existing systems to provide tailor-ed Izhaohu leadership negotiated with the services for their elderlies. local government and obtained rental [4.1.2] Fast response and forward- reliefs, tax reductions, social protection looking planning in leadership bene-fits, as well as financial support from local financial institutions. IZhaohu set up a disease prevention and control task force to coordinate responses [4.2] Necessary conditions to replicate during the outbreak. Following solutions government policies and appropriate The key elements of success are protocols and issued prevention and listed above. In order to replicate control, the task force sent requirements success overseas, the following through the employee-facing app and elements are indispensable: broadcasting across the entire company to ensure the information reached every [4.2.1] Professional information and single employee. IZhaohu leadership also communication technology (ICT) had strong public health awareness and

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In this case study, IZhaohu used internet 6.7 daily lives and provided contactless Value of Digital Technology in eldercare services. IZhaohu used AI technologies in cameras for automated Supportive Activities access control to the facilities, which greatly reduced risks of transmission. 6.7.1 To the government IZhaohu used big data analytics to analyze body vital signs of the elderlies and to The use of digital technology in supportive alert any issues. During the Covid-19 activities has provided the government a outbreak, caregiver manpower was limited, platform to communicate with the public, and family members of the elderlies were helping the government to maintain unable to provide the care they need. With effective communication and interactions ICT support, the caregivers were able to with the public, in a timely and efficient work more efficiently, and the family manner during the pandemic crisis. In members were able to receive eldercare addition, in the absence of detailed training remotely to ensure continuous standards for epidemic alerts, the care. information platform built by technology companies provided a reference for [4.2.2] Emergency response capacities relevant government departments, in eldercare institutions incentivized the local governments to improve the quality and effectiveness of Aside from technology reserves, the epidemic alerts, scientifically promoted implementation of many disease prevention knowledge, and thus measures demanded high emergency helped the government guide medical response capacities. By establishing a institutions to conduct diagnosis and complete response plan for acute treatment more accurately. infectious diseases and other crises, conducting regular response exercises, 6.7.2 To the public and actively carrying out relevant training in public health, IZhaohu improved the For the public, digital technology in ability of eldercare facilities in res- supportive activities helped to ensure their ponding to emergencies. These routine needs, from information, to medical and measures were also the basis of eldercare daily living needs. First, the new media institutions to deploy timely outbreak communication channels allowed for key prevention and control programs during information, such as outbreak situation the Covid-19 outbreak. and hospital information, to be promptly spread to a wider range of population. At the same time, ensured the quality of the information that are being delivered to the public, increasing public awareness, while

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minimizing unnecessary panic. Second, certain extent, the platforms alleviated the the involvement of artificial intelligence shortage of supplies in the medical system. and big data analytics can visualize complex and diverse information, provided the public with intuitive, understandable, 6.8 and convenient pandemic-related Limitations and Challenges information. Third, for special population groups who need long-term care, especially the elderlies, technologies such 6.8.1 The information posting platforms as the Internet of Things, big data, artificial are highly homogenous intelligence, helped achieved remote care at the onset of the outbreak, numerous and health management during the media platforms published information outbreak, minimizing the infection rate, columns of high degree of homogeneity. severe cases, and deaths among the The process of delivering messages across special population groups. the platforms, due to insufficient 6.7.3 To healthcare system explanations and insufficient supervision, was susceptible to mis-interpretation and In the early stage of the outbreak, Internet inaccuracy. platforms, new media Platforms and other channels shared immediately the first-line In the future, the government can take the clinical experience with the entire country, lead or provide guidance to relevant and around the world timely. The platforms platforms in the early stages of the provided information for medical development of public emergency events personnel with clear professional training and use advanced technologies such as and detailed specifications for healthcare artificial intelligence and big data analytics workers. This improved the professional to collect, integrate, verify, and release the skills and response capabilities of the information. medical personnel, enhancing the 6.8.2 The resource supply information efficiency of the medical system in platform failed to provide thorough, prevention and control of Covid-19. In comprehensive, and complete process addition, the construction and the information application of Internet platforms and cloud platforms helped medical material supply The resource supply information platform information to be effectively collected, during the pandemic had only partial verified, disclosed, and supervised, which supply and demand information, thus is conducive to efficient communication unable to support centralized between the supply and the demand side, management and deployment. In the enhancing the transparency of material future, the information platform can supply and demand information, and extend the integrated data to both ends of expanding the mate-rial supply base. To a the supply chain by joining suppliers,

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logistics companies, government departments, and charitable organizations. Together, they can create an integrated data platform for the complete process, including resource production, supply, transportation, receiving, and quality control, strengthening effective management and deployment of resources.

6.8.3 Lack of linkage among fund- raising platforms

Similar to the information dissemination platform during the outbreak, the fundraising platforms were also highly homogenized, however, each was working alone. How to connect the various fundraising platforms to one another, sharing resources and leveraging on each differentiated services for different donor groups needs to be further explored.

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Efficient long-term management is the key to driving socioeconomic recovery in the post- epidemic era. This chapter will sort out and discuss how digital technology can help companies safely resume work and help communities reduce risk of cluster infection.

7.1 Digital Technology in Long-Term health information, and helped the Management government timely grasp the status of local company work resumption. At the same time, the system provides a scientific 7.1.1 Support business continuity for basis for the governmental departments to companies and employees control work resumption dynamically, promote normal disease prevention and As the Covid-19 epidemic gradually epidemic control, while ensuring socio- normalized, all sectors of society began to economic recovery. resume production and operations. Under such circumstances, the prevention of 7.1.2 Assist communities with refined risk large-scale community transmission was, management and still is, an important basis for ensuring the orderly resumption of work. The As the basis for joint prevention and establishment of an integrated control of the outbreak, communities need information system and the use of the to strengthen the screening and data center can realize the information management of suspected cases, timely communication between employees, grasp the health and mobility information companies, and governments. This of residents and track high-risk groups to enables for timely monitoring of the risk reduce the risk of clustered infections in of outbreak in a timely manner, ensuring a the community. Management platforms safe environment for work and production based on technologies such as the resumption. Internet, the Internet of Things, artificial intelligence, and big data analysis can For instance, Mininglamp Technology complete information collection, Group developed the "Mininglamp intelligent classification, monitoring, and Intelligent Resumption Management early warning through automated calls. System". By eliminating communication The platform can help community workers barriers between employees, companies, carry out refined management of various and government, the system can realize population groups in the region, reducing smart calculation of employee infection the workload of community workers and risk and the quick filing of employee improving management efficiency. return to work applications. The system helped companies carry out unified For instance, based on technologies such as cloud computing, big data, and artificial

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intelligence, Internet Plus, JD Digital and [1] BACKGROUND: Integrated Yidu Cloud implemented smart Management Facilitates Return to Work information collection in the community and provided in-depth analysis and data, Ensuring the orderly and stable re- effectively improving the efficiency and operation of business, protecting the vast quality of community disease prevention number of employees to return to work in and epidemic control. JD.com and Concox a safe environment, and promoting the implemented smart temperature-sensor resumption of local economies are key screening, entry and exit registration, non- focuses in the new normal of Covid-19 contact elevator access and other control. In order to reduce the risk of information management and visual cluster outbreak, companies need to management based on artificial review and manage their employees' return, intelligence, the Internet of Things, and and local governments need to fully grasp other technologies to prevent the spread and oversee the work resumption progress of Covid-19 in the communities. of each company. However, waves of groups of employees returning to work across various locations have brought on 7.2 new challenges to information registration, risk identification, and epidemic control. Case Study X: Mininglamp The integrated work resumption Technology management system can assist employees, companies and the local governments to efficiently remain in contact with one ABOUT Mininglamp Technology another, which is an important basis for the orderly work resumption across Mininglamp Technology is a technology different industries. company that provides integrated artificial intelligence enabled products [2] CHALLENGE: Lack of an Integrated and services platform, dedicated to Work Resumption Management System exploring the incorporating and utilizing a new generation of artificial intelligence in At the onset of the Covid-19 outbreak, industries with high complexity of prevention and control measures were knowledge and management. Its core mainly focused on spread containment, technology is a unique Human population tracking, case reporting, Intelligence, Artificial Intelligence and contact tracing, and medical services Organizational (HAO) Intelligence System. provisions. As Covid-19 began to normalize, Mininglamp Technology offers services in a work resumption management system, the fields of smart industry, smart finance, especially one that can highly integrate smart city, smart analysis and decision- operations and functions required by the making, and data middle platform for government, companies, and employees, companies. became the next priority. In order to

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ensure to provide safe environments for a safe working environment, Mininglamp work resumption, the companies needed Technology launched its MingAn Intelligent Work Resumption Management health status and understand their travel System (Hereinafter referred to as MingAn histories. However, due to the lack of System) on February 13, 2020. The MingAn professional guidance, the information System established an "employee- collected and the standards for company-government" information closed information review varied across loop through data middle platform, companies. It was very likely for a artificial intelligence, cloud platform and company to mistakenly approve work other technologies. The MingAn System resumption for an employee who was created three terminals for employees, actually a suspected case, which further companies and the government, enhanced the risk of transmission. respectively, and provided different Moreover, due to inadequate or functions of management or service for incomplete information collection even each. Services included information filling, when a case was confirmed, it was hard to information query, resuming application, resuming application review, statistical the company in a timely manner, bringing analysis, and online services. yet another challenge to epidemic prevention and control. For the [3.1] MingAn System collects data government, work resumption meant an information from three terminals influx of a large number of populations, The data of the MingAn System consists of and thus the prevention and control three parts: employee personal measures were focused on within each information, company-related information, company. With various information and public information. Before officially collection methods being used across returning to work, employees are required different companies, the government to fill in their basic information, current needed to devote more manpower, residence, recent travel history, immediate resources and time to verify the family members, health status, and other information. This not only did not help information on the employee interface. For increase work efficiencies, but also did companies, they need to submit their not mitigate the risk of cluster infection management data, epidemic prevention for the companies. and control strategy, resumption [3] SOLUTION: MingAn Intelligent Work application information, from the company Resumption Management System interface. For the government, it needs to upload public information such as In response to the urgent need for work confirmed cases data, and the visited sites resumption, to help the government of confirmed cases on the government manage companies re-opening and interface. The MingAn System is a web- employees returning to work, and provide enabled system. Employees can use

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WeChat, Alipay and other apps to access public areas through the MingAn System the employee interface by scanning the to keep track of the epidemic risk level official access QR code, while across different regions. The government government agents need to log in to the can also evaluate and approve work web service via PC or laptops or tablets. resumption applications submitted by the Managers of companies can access the companies through the system. company interface via both apps by Companies can acquire risk identification scanning the QR code and PC or laptops data from the system after submitting or tablets. relevant information and their applications for work resumption. Upon government [3.2] MingAn System realizes efficient evaluation and approval, MingAn System communications among three terminals will send work resumption permissions to the companies who meet the requirements. Once employees, companies, and the government input and submitted their Once a company resumes work, its data, all the data and information will flow employees need to fill in their basic health into the data middle platform for information on a daily basis and enter their aggregation. Through efficient processing office with their health QR code generated and artificial intelligence identification, by the MingAn System. Based on the the system will send each employee a risk information filled by employees, the level assessment and a public access system will generate "Today's Health permit, in the form of a health QR code. At Statistics and Analysis" for the company the same time, the government can obtain and report it to the government. In data on the risk-identified population in addition to multilevel approval and review

Figure 15. Components and information exchange flow of MingAn System

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of the list of employees returning to work, in areas with large numbers of migrant the functions for the government also employees and local companies, in include data statistics and analysis, which locations such as Zhejiang Province and quantitatively monitor the dynamics of Guizhou Province. Taking Beilun County, region-al epidemic prevention and control. Zhejiang Province as an example, within 10 This helps the government accurately and hours of the MingAn System's release, effectively monitor the companies and there were more than 1,000 applications employees returning to work, greatly from companies requesting return to work, dampening the risks of sudden clustered and hundreds of thousands of employees infections, enhancing the ability of quick registered and submitted their information. investigation after the occurrence of cases, Further, the government also thought and ensuring the sustainability of work highly of the system. The key success resumption. factors for the MingAn System can be attributed to the following three aspects: [3.3] Mature and reliable partners ensure the safe and efficient operation of the [4.1.1] Adjustment of the system MingAn System construction plan in time according to progress of the epidemic In order to ensure the normal operation of the MingAn System and the efficient flow The most important feature of the MingAn of data, Mininglamp Technology System is that it takes into account the established a system server jointly with needs and the connections among China Unicom, a Chinese state-owned employees, companies and the telecommunications operator of China. In government in terms of work resumption. addition, in order to avoid data security The intricate design allows functions for issues such as information leakage, theft, three different types of user to access for and fabrication of employees and their respective needs, ensuring timeliness companies, Mininglamp Technology and the effectiveness of the two-way collaborated with mature service providers information communication. Further, due such as Huawei Cloud and Ten-cent Cloud. to the rapid changes of the Covid-19 This collaboration allowed Mininiglamp epidemic, the requirements of employees, Technology to launch its MingAn System companies, and governments for work in a very short time, providing employees, resumption management system changes companies and the government with safe, as well. Therefore, the MingAn System is reliable, and timely management services. not static. Instead, it has been progressively updated and refined to [4] DISCUSSION ensure it follows the progress of the outbreak. The MingAn System began as a [4.1] MingAn simple questionnaire system, with an factors updated version of the system released MingAn System had a high utilization rate every day. After three weeks, the

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requirements for work resumption [4.2.1] Informatization infrastructure management system were gradually stabilized, and the MingAn System that MingAn System integrates all information integrated employees, companies, and of employees, companies and the governments slowly finalized. government into one integrated system, effectively breaking the information barrier [4.1.2] Technology accumulation and caused by the hierarchy, and thus manpower input guaranteed the facilitating the timely and accurate epidemic prevention and control. Data informatization is the basis for the MingAn System integrates many data successful establishment of the system. If systems and technologies, including data there were no equipment for the Internet, middle platform, artificial intelligence servers, terminals, and infrastructures for technology, and cloud services. In the information and communication case where the system needs to be technology, the MingAn System could not quickly built and launched, the have been realized. accumulation of experience in various technologies and applications is essential [4.2.2] Use of the data middle platform to the success of the system. In addition, a large amount of manpower input is also The data middle platform collects, crucial in accelerating system calculates, stores, processes and construction. After receiving the standardizes massive data, which is the requirements for work resumption basis of big data analysis. This is also the management, Mininglamp Technology most important technology for the MingAn established a work team of more than 20 System to break the information barrier people instantly. Though the team worked and build the "employee-company- remotely, they completed the design, built, government" information closed loop. and launched the system within just 4 [4.2.3] Ensuring data security days. MingAn System attaches great importance [4.2] Necessary conditions to replicate to the security of information, and Mininglamp therefore collaborates with many well- Presently, the Covid-19 pandemic in many reputed companies in the digital European and Asian regions have been technology industry to ensure that data effectively controlled. Reopening the can be transferred at high speed, while economy and returning to work has ensuring security and privacy. While the become a priority. If there is need to collection of information and data is a replicate the success of the MingAn prerequisite for the operation of the system in overseas countries or regions, MingAn system, being able to stably and the following 3 necessary conditions need reliably ensure data security is a necessary to be met: condition to gain the trust from all users,

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and to develop and promote such system Things (IoT), and blockchain, to help sustainably. financial and real economy sectors re- duce costs, improve efficiencies, optimize [4.3] The development of the MingAn user experiences and advance business System models. To date, JD Digits has established its positioning in areas including smart The successful launch of the MingAn cities, fintech, and smart robots, serving System helps the orderly process of work different types of clients, from individual resumption. Standing on this basis, customers and corporates, to Mininglamp Technology continuously governments. expands the source of data connection, and tailors its system for community [1] BACKGROUND: The Importance of management and school resumption Community Screening during the Covid- management, to help communities and 19 Outbreak schools obtain multi-dimensional information of the different population Local communities take on a critical role in groups. The system improves the outbreak control. During the Covid-19 efficiency for communities and schools to outbreak, there was a need to increase the investigate and deal with potential capacity of disease detection and infections and reduces the risks of management of suspected cases in the transmission and contain the spread in a communities. It was crucial to time timely manner. capture the health status and mobility of the community residents, and to monitor contact tracing of high-risk individuals, in 7.3 order to reduce the risk of developing community outbreaks. Therefore, a Case Study XI: JD Digits comprehensive community management was initiated to gather essential ABOUT JD Digits health status, travel history, and close JD Digits, formerly known as JD Finance, is contacts to achieve community outbreak a technology company that provides control. In addition, for citizens under digital services. JD Digits spun off from home quarantine, the community JD.com in October 2013 and rebranded as screenings can help understand better the JD Digits. It is one of the three major needs of the residents. The collection of independent subgroups of JD.com; JD Retail and JD Logistics are the other two. health status and needs allowed JD Digits leverages the latest and most community managers to promptly cutting-edge technologies, including big understand the spread at the community data, artificial intelligence (AI), Internet of level and to act accordingly.

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[2] CHALLENGE: Manual Implementation Manual implementation of community of Community Screening was screening demanded massive manpower, Impractical inefficient, and time consuming. According to a population census, there Albeit the importance of community are at least 3000 families in each district, screening as a means to understand the in a city. Even by means of telephone community health status, there were survey, at an average of 10 minutes per many difficulties during implementation. teleconsultation, it would require up to This operation requires for a wide area of 500 hours to complete a community coverage, which is demanding in both the screening for 3000 families. Evidently, number of employees and workload. It door-to-door visit would take even longer. also increases the risk of transmission. Moreover, for suspected cases and high- Therefore, traditional manual risk individuals, continuous follow-up implementation of community surveys would be needed. Therefore, investigations was not feasible during the communities needed a solution to replace Covid-19 outbreak. The challenges were manual community screening to increase manifested in the following three aspects. the efficiency and frequency of the surveys. [2.1] Traditional door-to-door com- munity screening method increases the [2.3] Manual implementation of risk of transmission community screening cannot export data in a timely and efficient manner for Traditionally, door-to-door community data integration and analysis screening was conducted by community workers and volunteers. However, the risk Another drawback of the manual of transmission was very high during the implementation of community screening is outbreak, which was adverse to outbreak its inability to export survey data timely control. Further, the employees may come and efficiently for subsequent data into close contact with potential carriers integration and analysis. Traditional when conducting community screening, surveys required manual data entry and hence all employees would be required to upload. This process is not only laborious, wear protective gears. This added but also does not guarantee data quality. additional pressure to the already scarce Therefore, how to properly for-mat, medical resources. Therefore, using integrate, and analyze the collected data remote telecommunication technologies became the main challenge. If the data to conduct community screening was the cannot be promptly collected and most ideal method during the outbreak. effectively utilized, then community outbreak would not be properly hand-led, [2.2] Manual community screening was losing the value in timely community inefficient, labor intensive, and time screening. consuming

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[3] SOLUTION: JD Digits Digitalizing contactless survey. Community Screening [3.1] JD smart outbound robot Targeting the three major limitations and demands described earlier, JD Digits Based on AI technology, JD Smart provided digitalized community screening Outbound Robot conducts one-on-one solutions, including two survey methods: telephone communications with the public, JD Smart Outbound Robot and JD Queries which can be used for community surveys, Survey or JD Liangyan Survey. Based on announcement broadcasts, and return JD software platform and WeChat platform, visits of key population groups. JD Smart JD Digits employ-ed data analytics, AI Outbound Robot facilitated large amount capabilities, and speech engine of data collection for the community and technologies to execute highly effective the disease prevention and control system,

Figure 16. JD Smart Outbound Robot operation logistics

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which significantly improved efficiency. data entry and upload by community For the workers returning to work, JD management employee, which diminished Smart Outbound Robot conducted the time required for data integration and automated telephone survey to record the analysis, hence drastically increased the details of their travel plans and health overall efficiency and accuracy of the status information. For the residents survey. within their respective jurisdictions, the Robot collected health status information [3.2] JD Digits queries survey and captured any difficulties in the daily JD Digits rolled out JD Digits Queries livelihoods of persons under quarantine. Survey mini-application to rapidly collect For the key monitoring personnel and feedbacks. With a few simple steps, the quarantined persons, the Robot data collector can easily create, edit, and conducted daily automated telephone disseminate the survey. Community surveys on their health status and alerted workers can share the screening survey in the community to take immediate two ways: share the link to the mini- intervention activities when any application via WeChat platform, or create abnormalities are detected. If there were a survey QR code, print and post it on suspected cases newly detected, the noticeboards in residential buildings for Robot will notify the nearby residents to scan and fill-in. JD Digits neighborhoods to take the necessary Queries Survey can be completed online measures for self-quarantine and and remotely, omitting the need for protection. contacts with the interviewers and the risk Presently, community management of transmission. employee only needs to provide the list of As a professional analytical tool for questions for JD Digits to configurate the research and analysis, JD Digits Queries questions into the system. Once the Survey can generate data rapidly, and community management employee logs gained positive feedback and credibility onto the system and uploads the internally within JD Digits. Therefore, JD Digits has made the online data collection the Robot will call each number system openly available to the public and automatically. The employee can revisit all the communities in need. For example, in call records on the system. The system Taolin, a town in province, JD will automatically generate data reporters survey system had optimized the of the call records, with simple AI analysis 37 existing information registration to alert any abnormalities for early stations to 22 enhanced stations, which warnings. did not only improve the information JD Smart Outbound Robot can conduct registration efficiency, but also alleviated multiple simultaneous telephone surveys the manpower shortage in their with speech recognition and semantics community disease prevention and control interpretation. This alleviated the need for measures.

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[4] DISCUSSION JD Smart Outbound Robot and JD Digits Queries Survey both are independent JD Digits has digitalized the community software systems. The solutions can be screening and provided important support to the community disease prevention and devices. In addition, as the whole soft- control measures. The success in the ware process can be visualized for the users, making it easily operable. These advantages greatly increased the technical resources; 2) The convenience replicability of the applications, hence in usage and replicability; 3) The achieved the widespread and large-scaled construction of community disease nationwide usage. prevention and control informatization is promoted by the national government. [4.1.3] National promotion of the Aside from the solutions used during the construction of community disease outbreak period, these tools would also be prevention and control informatization applicable for long-term community management. Community screening was an important element in community disease prevention and control informatization construction.

[4.1.1] JD Digits has vast technical promoted and regulated the application of resources community disease prevention and control informatization since the early onset of the JD Smart Outbound Robot and JD Digits outbreak. The guideline had set clear Queries Survey were both technical objectives and directions for the products available prior to the Covid-19 community disease prevention and control, outbreak. These two solutions only including systems settings, security required minor modifications to operate requirements, and privacy protections in during the outbreak for disease accordance with the public welfare prevention and control measures. The vast principles to foster a constructive technical resource capacity housed by JD ecosystem. Digits had not only reduced the time needed for research and development in Internet technology companies, when other products, but also reduced the collaborated with communities to develop potential errors during the use of the information surveys, may involve sensitive solutions as the solutions had already matters including information handling, been used and refined prior to their privacy details of the residents, and applications for Covid-19. certain public private partnership issues, which contributes to many hurdles in its [4.1.2] Solutions convenience and implementation. Under such replicability circumstances, the national government

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had offered unified guidance for [4.2.2] JD Digits queries survey corporations to facilitate community implementation requirements screening to achieve community disease prevention and control. The government In terms of hardware, JD Digits Queries provided model cooperation protocols in Survey required prevalent use of order to effectively leverage the smartphones or devices as proactiveness of corporations while telecommunication method. It also reducing the worries among the residents required the users proactively fill in and when implementing in the community. upload the survey data on their own. In This had drastically increased the overall terms of software, JD Digits Queries Survey speed of development and promotion to encompassed many software technologies achieve widespread coverage. including application development and data analytical software, which were [4.2] Necessary conditions to replicate already widely available.

Regarding in-app surveys such as JD Digits [4.2.1] JD smart outbound robot Queries Survey, the willingness and implementation requirements proactiveness for the public to adopt the app and complete the in-app survey with In terms of its hardware, JD Smart Out- quality data were integral aspects to its bound Robot required prevalent use of success. In China, it is common for the telephones and mobile phones as a government and community workers to foundation to roll-out the survey. In terms mobilize and carry out publicity efforts. of software, JD Smart Outbound Robot During the crisis, the teams even drafted used an automated dial system with relevant policies and regulations to speech recognition and semantics mandate citizens to truthfully report their interpretation, and AI enabled data data for community disease prevention and control. This step has greatly ensured the system, enabling functions including the timeliness and the accuracy of the data smart dial, smart recognition, and smart reported by the public. analytics. In practice, JD Smart Outbound Robot also required a robust community [4.2.3] Governmental supervision and information registration system. In the guidance past few years, China had an extensive plan to collect population census, using Regardless of using either JD Smart districts and communities as units, to Outbound Robot for automated out-bound reach full coverage of community calls to collect information or mini- registration. This provided a great applications to disseminate electronic information system foundation for remote surveys, the security and efficiency of the community screening. information systems to protect the data and safeguard privacy were essential

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considerations when designing the population groups. Therefore, detailed surveys. The government had set survey information can be collected by comprehensive laws and regulations advanced speech engineering specific to outbreak prevention and technologies with speech recognition, control measures. The regulations offered automated response, and AI prompted guidance in promoting the informatization conversations. Hence, JD Smart Out- of community screening, and promoted bound Robot is more suitable for orderly collaborations between designated population groups, such as corporations, local governments and newly returned citizens, suspected cases, communities to achieve community and persons with daily livelihood disease prevention and control. difficulties, as these groups require continuous collection of information, [4.3] Comparison between JD smart allowing more accurate community outbound robot and JD Digits queries screening and specific community disease survey prevention and control measures. Both JD Smart Outbound Robot and JD Digits Queries Survey were jointly used in 7.4 the community screening and community disease prevention and control measures. Value of Digital Technology in JD Digits Queries Survey is less Long-Term Management demanding in terms of software but required the use of smart devices and 7.4.1 To companies applications. Therefore, the Survey was more suitable for communities with higher For companies, digital technology can level of technology usage, and more often help eliminate potential dangers of with lower proportion of elderlies. JD epidemic spread and reduce health risks Digits Queries Survey also relied on the during work resumption. Online information collection and data However, due to the new regulations set connection eliminate the need for forth by the government, residents companies to manually collect daily health returning from other location are status on employees. The application of mandated to complete the survey, the data center can quickly analyze increasing the efficiency of information registration for the newly returned citizens. assessment back to the company to ensure the safety. JD Smart Outbound Robot has advantages in the ability to make pre-selections within 7.4.2 To the public communities to assign designated regular For residents who are isolated at home, return visits, which increased the digital community management can assist frequency of survey among targeted

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 121 Long-Term Management them to report back to the community 7.5 about their living difficulties and needs during the outbreak and receive necessary Limitations and Challenges and timely support. For those who need to return to work and study, the Internet platform can help them achieve remote 7.5.1 Government guidance and work and study, while avoiding the risk of regulations need to be refined reinfection. For people who need to return to work offline, information system such as personal information for work resumption the smart management system can enable personnel risk assessments and conduct community management, privacy and return-to-work approvals online to ensure security are matters of public concern. employee safety and reduce the risk of Presently, many companies and infection and transmission. communities are jointly carrying out digital 7.4.3 To the government smart management solutions. The government should continue to improve The application of digital technology in the corresponding regulations and strengthen long-term management can assist the supervision and management, to provide government to promote socio-economic detailed and standardized guidance for recovery, at the same time maintain community screening. outbreak control. In the process of outbreak control, societies may 7.5.2 Public awareness and coordination experience social and economic with smart management need to be disruption. As the Covid-19 epidemic strengthened gradually stabilized in China, the The successful application of digital government urgently needed to vigorously technology in long-term management promote work resumption to restore the cannot be achieved without public trust orderly operation of society and economy, and cooperation. At present, many people, while ensuring safety. The establishment especially the elderly and the people with of an integrated information system, lower levels of education, have nominal coupled with the application of knowledge of the Internet of Things, technology such as data center, artificial Internet, artificial intelligence, and other intelligence, can help the government technologies, and thus they do not trust or timely capture work resumption status, find it difficult to cooperate with smart epidemic prevention, and control situation management system using technology. In in a timely manner. With the information, the future, society still needs to strengthen the government can take corresponding public education and improve public measures and guide the companies and awareness of and access to advanced communities to carry out precise outbreak technology solutions such as digital management and services. technology. This has become

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 122 Long-Term Management

especially critical during the fight against Covid-19 epidemic and will be of same importance in times of any future public health emergencies.

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 123 COMPREHENSIVE DISEASE CONTROL SYSTEM Comprehensive System

8.1 ABOUT Alibaba Group Alibaba Group (Alibaba) is an e-commerce Digital Technology in conglomerate founded in 1999, Comprehensive Digital headquartered in Hangzhou, Zhejiang Prevention and Control System Province. It offers services ranging from B2B commerce, online retail, and shopping search engine, to third party During the Covid-19 epidemic, all payment services and cloud computing stakeholders including governments, services. The Group's subsidiaries include healthcare system, communities, Alibaba B2B, Taobao, T-mall, Alibaba Cloud enterprises, and the public, need the Computing, Alipay, Ant Financial, DingTalk, support of data and information to carry and more. It is currently one of the largest out prevention and control strategies. The retailers in the world and has contributed comprehensive digital prevention and to dozens of smart city and government control system based on digital digitalization projects since 2015. technologies such as Internet platforms, big data analysis, and artificial intelligence [1] BACKGROUND: The Importance of a can realize the efficient information Digital Prevention and Control System connection in the region. The system can strengthen and facilitate communications Comparing to SARS in 2003, Covid-19 among all stakeholders, improving outbreak unraveled at a much faster pace efficiency in coordination of various and a larger scale. China today is also moving parts in the fight against the drastically different from 2003, both epidemic. economically and socially, the country now has a larger population participating For instance, Alibaba collaborated with in more economic activities. Given these Zhejiang Provincial Government to launch socioeconomic changes to the country, -19 Prevention and Control China needed a more comprehensive disease prevention and control strategy 20 functions, the Platform connected the during the Covid-19 outbreak than in the information and communication among 2003 SARS outbreak. China has also been residents, com-munities, healthcare going through a digital reform. Therefore, system, and local governments, forming a Chinese government actively encouraged provincial-level comprehensive digital the use of digital technology to prevent prevention and control system. and control Covid-19 outbreak. In an announcement released on February 3, 8.2 2020, the National Health Commission pressed local authorities to utilize digital Case Study XII: Alibaba Group health technology to assess the outbreak situation, to develop new diagnosis

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 125 Comprehensive System

systems, and to support relevant services significant during the early onset and peak during the epidemic. of the spread. Three information systems are especially important in this process: [2] CHALLENGE: The Lack of an the epidemiological and disease control Integrated Platform for Governmental, system, medical service and management Medical, and Community Services system, and the resident information statistics system. All three systems are During the Covid-19 outbreak, real-time highly demanding in data gathering and data and information are very important analysis during the epidemic. Traditional elements in disease control and information systems are unable to meet prevention efforts. However, the both the needs to upload sizable volume traditional information systems are not of information and the need to rapidly easily integrated. Further, most digital analyze the collected data during a technology companies are only able to epidemic outbreak. It is thus necessary to provide one service, or at most a handful design a data input system and a database of services, to support a specific aspect of catered specifically to Covid-19. the larger disease prevention and control strategy. There is thus a need for a Meanwhile, the public also need to have centralized and integrated system to access to updated information and news coordinate these different components on Covid-19. As a result, making efficient contributing to disease prevention and and timely information dissemination control. An integrated information became very critical. Further, during the platform would allow data to be outbreak, governments, communities, and aggregated and then disseminated to medical institutions all need to different parties more efficiently. Medical, disseminate Covid-19 related information, governmental, and community from epidemic updates, medical organizations would also be able to better information, and epidemiology, to contact share and communicate information on tracing, policy development and the outbreak with one another. In turn, an community management. However, how to integrated platform would reduce each ensure transparent, authoritative, and easy -load and raise its to understand information are being productivity, which is especially valuable disseminated to the general public given that human and material resources became a major challenge. were limited during the Covid-19 crisis. [2.2] Reduce burden and increase [2.1] Traditional information systems fail efficiency via prevention and control to meet information dissemination measures needs during an epidemic The Covid-19 outbreak puts tremendous Gathering timely and accurate information pressure on community and medical is critical to controlling the spread of a services. In terms of community services, disease outbreak. This is even more

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community volunteers and employees out disease prevention and control need to conduct a comprehensive health measures. An integrated information checks and key population group platform became necessary. registration and tracing, enhancing risk of transmission. However, the work required is extremely labor intensive and runs risks Covid-19 Prevention and Control Public of transmission. Similarly, in terms of Services Platform" medical services, increased number of Alibaba, along with its subsidiaries, built patients over-whelmed local hospitals and an integrated public services platform for depleted medical resources. Traditional Zhejiang Province. The Group collaborated modes of offering medical resources with the Zhejiang Health Com-mission in through physical hospitals can no longer late January 2020, and mobilized its satisfy medical needs during the epidemic. expertise from Alibaba Cloud, Alipay, With digital technologies, conducting DAMO Academy, Alibaba Health, DingTalk, and Yida. Together, they built an tracing, and medical consultation can all integrated epidemic-related services be done remotely, alleviating burden for platform within just 24 hours. The Platform not only the residents, but also the consists of four categories of services : community employees, medical personnel Residents, Community, Medical institutes, and hospitals. and Administrative management and [2.3] Government lacked an integrated services. These four categories information platform to support its encompass around 20 services in total. policy decisions [3.1] For residents: self-declaration and Due to the high infection rate of Covid-19, communication and the return to work travels after the Chinese New Year, the prevention and provided Zhejiang residents with two control measures became even more types of services reporting and receiving intense. In addition, with information on information. In reporting information, the Covid-19 coming from various sources, Zhejiang residents were able to self- it was difficult for the government to declare their health status and report obtain timely updates from various data suspected Covid-19 cases via the Platform. systems. There were three types of system Residents could access these functions by that were critical in informing government decisions: epidemiological monitoring their Alipay application, where they could system, hospital information system, and then report suspected cases near them. com-munity information system. Without Once a resident reported a suspected simultaneous updates from these systems, case, they were contacted for follow-up the government could not make timely questions. Residents could also input their and informed policy decisions, and carry daily health status on Alipay, and the

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health status survey included question on observation and management, centralized medical observation and management, contacts, travel histories, and more. The and more. When the Platform launched, its survey took less than five minutes to system connected nearly 400 hospitals in complete. Zhejiang, with over 40 thousand doctors ready to provide internet medical services. In terms of receiving information, the These doctors were able to prescribe platform provided a number of services. medications online, and once a pharmacist One of them allowed residents to verified the prescription, the prescribed retrospectively look up whether anyone medication would be delivered to the on the same public transport had been confirmed with Covid-19. Users could do receive professional medical services so by logging onto their Alipay application without leaving their doorsteps. and entering the date, train or bus number, and region in the search engine. The [3.2] For communities: information Platform launched in late January, by early collection and population management February, the search function had already reached over 30 million in search volume. The Platform helped community managers

The Platform also provided residents and record visitors entering the online medical services through the - Zhejiang Province Internet-based Hospital. system, for instance, was a cloud-based Services offered included online smart call center, where intelligent robots made consultation, online psychological phone calls to residents and asked counselling, home-based medical questions related to the outbreak situation.

Figure 17. -19 Prevention and Control Public Services

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 128 Comprehensive System

The system could also answer calls from The Platform also helped medical the public and engage in conversations institutions better manage their resources with the callers about Covid-19. With its and work performance. Services provided voice recognition technology, the system include fever clinic registration, fever and then turned these phone conversations suspected case reporting, diagnosis and and respondent answers into tables and follow-up system, medical supply statistical reports. Community managers management, intelligent phone call system, could also design and set their own Covid-19 case database, and many more. questions that would be asked in the Most notably, the Platform allowed phone calls. Comparing to traditional, hospitals to manage multiple manual phone calls, the intelligent robot administrative systems through one single, system was able to make multiple phone integrated platform. Specifically, the calls at once specifically, around 100 Platform allowed hospitals to manage up thousand calls per hour. The system to 50 administrative systems, 40 kinds of drastically improved community information systems, and over 700 hardware systems on the Platform. This capability, allowing community personnel meant that when a new Covid-19 patient to conduct check-ups on residents more efficiently. registration, health status report, and the entire treatment and recovery process Communities also had to register could be managed via a single platform. incoming visitors as part of population Alibaba also provided medical databases management. To meet this need, Alibaba, catered to Covid-19 data and helped in collaboration with its subsidiaries doctors make informed clinical decisions. DingTalk and Alipay, developed a sub- program within Alipay that allowed To support the treatment of Covid-19 communities to collect visitor information. Once community managers applied to use the system via Alibaba Cloud, they would Artificial Intelligence (AI) based CT Scan be able to download community-specific system. The system could read and QR codes and paste them on community billboards or entrances. Visitors could within just 20 seconds and assess the then simply scan the QR code and enter their information into the system. This sped up the process of visitor registration During the Covid-19 outbreak, more than a and freed up additional human resource thousand hospitals in Zhejiang needed to within communities to focus on other ensure that they were receiving sufficient disease prevention and control measures. medical supplies. In order for authorities to appropriately distribute medical resources, [3.3] For hospitals: more efficient these hospitals had to regularly report resource management their medical supplies to district,

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 129 Comprehensive System

county, city, and provincial-level integrating information from different authorities. The traditional method used administrative levels. With its data excel sheets to summarize the level of visualization function, the system also medical supply made the reporting helped government agencies better process tedious. Integrating the reported understand the epidemic situation and data was time consuming, data were often make informed decisions. lost in the process, and feedback from As the economy gradually reopens in system allowed hospitals to quickly report Zhejiang Province, the government also their medical supply levels. The system then integrated these data to inform adjust its policy measures. Specifically, the resource distribution decisions. government focused on a few key indicators to support their decisions. [3.4] For the government: policy These indicators include the number of decision support people under quarantine, people who have been in close contact with con-firmed In order to help the government to cases, people who have been to high risk improve their productivity, the Platform areas, people exhibiting symptoms, and offered work management and policy decision support. "Smart Covid-19 Q&A system also allowed government agencies Robot", "Government DingTalk Video to monitor at-risk population, manage Conference", and "Covid-19 Special industrial areas, and other populations key Taskforce" services helped government to manufacturing. Government personnel improve work capacity and efficiency are able to access information on a single during the outbreak. Other services like platform and focus on maintaining one "Epidemic Information Collection", information system instead of multiple "Epidemiological Tracing", "Epidemic systems, drastically reducing government workload and pressure. policy decisions. Notably, to address population management in hospitals, train stations, The system can support real-time import super-markets, and other administrative of data from multiple departments, and simultaneously conduct statistical analysis and produce reports. The system also generated analysis reports with on Alipay and enter their health status, information from the local Center for current location, and contact history to Disease and Control (CDC), hospitals, and - other sources. This removed the time input data is verified against the consuming and complicated -coded QR administrative processes involved in code is generated. This serves as a permit

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 130 Comprehensive System

that determines whether the permit- to its extensive products and technology holder is allowed to enter or travel to expertise accumulation. In engineering the certain areas. Color green indicates that Platform, Alibaba Group engaged multiple the health code holder is allowed to travel and enter freely, whereas the yellow and leading cloud service developer, Alipay, red codes indicate that the code holder one of highest market penetration in needs to be quarantined for 7 days and 14 mobile payment industry, DAMO Academy, days, respectively. Once the code holder serves the quarantine and updates their innovation, Ding-Talk, a highly applicable health status as requested, the code will business communication application, and automatically turn green. Likewise, the Alihealth, with presence in online code color changes with the user, as the pharmaceutical retail, internet-based hospital, consumer medicine, and smart location change. A trial version of the medicine. The wide range of digital products that Alibaba Group had Yuhang District, Hangzhou City on developed prior to the Covid-19 outbreak February 4, 2020 and was officially laid a solid foundation for its work during launched in Hangzhou on February 11, the epidemic. 2020. Within three days after its launch, In addition, Alibaba's own reserve more than 35.3 million times. By February technology also played a role in the outbreak. An example is Yida, a website cities throughout Zhejiang Province. builder that allows users to drag-and-drop elements to design their website. During physical check points and allowed the Covid-19 outbreak, Yida was used to different organizations to reopen their build multiple medical platforms. This services as the economy opens up. This solution helped build the digital disease also reduced government expenses, and prevention and control system. by mid-March, more than 200 cities in [4.1.2] Experience in smart city and digital urban planning projects [4] DISCUSSION Zhejiang Province is known for its digital technology industry and has always been -formation. [4.1.1] Technological expertise across a In particular, Alibaba, being headquartered variety of products in Hangzhou City, has been deeply involved in the development of internet A key reason Alibaba was able to develop and digital technology application in the such a comprehensive digital disease Zhejiang Province for many years. In prevention and control system and to be particular, Alibaba Cloud has played a utilized at a provincial level was attributed

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 131 Comprehensive System

crucial role in building the brain of planning, to consumer goods to ensure Hangzhou city. With the onset of Covid-19, that the resulting product provides the smart city brain developed in comprehensive Covid-19 related services. Hangzhou in recent years has been fully Second, the enterprise would also need a technical team that could support the experience in establishing Zhejiang basic algorithm, internet, AI, big data, Internet of Things, and communication medical, environmental, and industrial and technology behind the Platform. Third, the other fields, it was able to quickly build a area where the project would be launched set of integrated digital solutions to tackle needs to have basic digital and information Covid-19. technology infrastructure in place. Fourth, a comprehensive service platform would [4.1.3] Close collaboration with the require a high level of support from the government local government to remove administrative hurdles. At last, most residents within the With the strong support from Zhejiang region would have to be familiar with basic digital technologies, such as cell phones, was able to develop digital services that lap-tops, and so on. covered the entire Zhejiang Province area. Close collaboration between the two Covid-19 prevention and control public Health Commission was able to clearly services platform communicate its demands and needs to Alibaba, whose team then developed the Shortly after Alibaba launched the Platform products to meet those needs. During the in Zhejiang Province, the National Health Commission expressed its strong approval Health Commission helped Alibaba for the project. In mid-February, the cleared administrative red tape and National Health Commission sent out a hurdles, accelerated the launch of the feature report to encourage and urge local -19 Health Commissions across the country to Prevention and Control Public Services implement similar projects. Based on our Platform has become an exemplary public- current under-standing, the Platform has private partnership. been provided to all local governments and com-munities across China free of [4.2] Necessary conditions to replicate charge, and it is now being used across more than 30 provinces, autonomous regions, and municipalities outside of Zhejiang Province. Due to different levels pre-conditions be met. First, the enterprise of basic digital infrastructure in place in leading the project would need to have these regions, each region is using expertise in a wide range of industries different combinations of functions on the from medical, communication, urban

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 132 Comprehensive System

- system. This Platform fully even the social ever, has become widely used within governance system. This Platform fully China, with over 70% of cities using the system and will undoubtedly influence other regions developing similar products. future digital health developments. The expertise, technology, scale, and basic infra-structure involved in this project, 8.3 however, make it difficult to be replicated Values Limitations, and and scaled-up within a short period of Challenges of Comprehensive invaluable insights and inspirations for Digital Prevention and Control both China and international regions. This System case demonstrates that establishing basic information technology and digital The comprehensive digital prevention and infrastructure now, is important for future control system is an integrated system disease prevention and control. The case that encompasses all of the applications also shows, given the urgency of the of digital technology described in this epidemic situation, prioritizing key report. All of which participated in the services and functions in the fight against Covid-19. This integrated comprehensive system can directly system realizes the interconnection of various information in the region and and control ability. provide accurate support on decision- making and management for the government and communities. It can also help the healthcare system improve efficiency, optimize resource allocation, and provide residents a convenient platform to report to and obtain information from.

-19 Prevention very special case of a fully integration of digital technology in outbreak prevention and control. Considering the current level of digital technology development in is a high-level utilization of digital technology to support the healthcare system, and even the social governance

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 133 CONCLUSION & REFLECTION Conclusion and Reflection

Digital technology has emerged and released great value in response to the Covid-19 pandemic. The new generation of digital technology such as artificial intelligence, big data, and 5G has played an important role in the entire process of epidemic prevention and control. The technologies support measure from governmental decision-making support, epidemiologic research, healthcare delivery, epidemic information reporting, and professional knowledge training, to resources mobilization and donations, social governance, working and daily living. The applications of digital technology not only improved the effectiveness and efficiency of epidemic prevention and control, but also drove the digital innovation in the entire emergency response management system.

Through in-depth understanding and accelerate the development of drugs analysis of 12 digital technology enabled and vaccines. case studies, this report offers a comprehensive view on the different • Faced with rising healthcare demands digital technology interventions in the during the pandemic, the fight against Covid-19 in China. The role implementation of digital technology and impact of these interventions can realized telemedicine and remote health be summarized into the following management. These solutions aspects: minimized cross-infection among patients, effectively improved the • Digital technology improved the quality diagnosis and treatment capacity and and efficiency of governmental efficiency of frontline healthcare decision-making in response to public providers and alleviated the shortage of health emergencies by assisting the medical services and resources. government in managing epidemic prevention and control, such as • In supportive and volunteering activities, integrating data, analyzing outbreak digital technology established a progression, identifying and tracking platform for efficient communication high-risk groups. between the government and the general public. It also assisted in In terms of epidemiological establishing reliable platforms for investigation, the use of digital medical supplies and donations and technology has accelerated the provided support for the more research of gene sequencing and vulnerable and elderly population protein structure of Covid-19, the groups. prediction of the scale of transmission and epidemic trends, improved • As life during pandemic outbreak understanding of the virus, enhanced became the new norm, digital the diagnosis and treatment capabilities technology became, and still is, a of the medical system, and assisted powerful management tool in pharmaceutical companies to supporting work and production

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• resumption, and community Technological foundation: The management. Digital technology technological foundation is essential to became an indispensable in helping the promote digital response. Over the past government to reopen the economy, two decades, China has experienced accelerate social and individual recovery. large-scale digital transformation. Thus, communication technologies, such as The impactful applications of digital smart devices, Internet, and social technology in the Covid-19 pandemic media, have achieved widespread usage was not accomplished overnight, but and popularity. Meanwhile, cutting-edge rather through accumulation of many digital technologies, such as Internet of technology developments and reforms. Things, artificial intelligence, big data Based on 12 case studies, we analyzed analysis, and 5G network, have the key success factors and necessary developed rapidly. The accumulation conditions for digital technology to fight and usage of these technologies against the pandemic. We summarized prompted the rapid participation of China's key success factors, across digital technology in the fight against three levels: 1) government; 2) social; 3) the pandemic. enterprise, described in the table 3. • Data foundation: The informatization of For other countries and regions, the data is the most basic element for the following four conditions are application of digital technology. The ability to aggregate and analyze the experience in promoting the full various sources of data, while ensuring application of digital technology in data security and privacy provided a combating the pandemic: 1) user foundational environment for the adoption; 2) technological foundation; 3) epidemic response using digital data foundation; 4) governmental technology. Without connected support. networks, servers, and terminals, information and communication • User adoption: The extent of the technology and other infrastructures, application of digital technology in tools that can guarantee data pandemic prevention and control is informatization and data security, digital dependent on the level of public enabled epidemic response could not acknowledgment and cooperation. Only have been achieved. when users are able to and willing to provide feedback on information • Governmental support: Fight again the required can companies design and Covid-19 crisis has been a battle that modify tailored digital solutions, and requires unity among all. It requires can government obtain effective leadership from the government levels information in a timely manner to to guide and control the pandemic accurately deploy prevention and responses. From information control measures. dissemination, resource mobilization,

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Levels Key Success Factors

at the onset of the outbreak, National Health Commission clarified the important role of information system in epidemic prevention and control. In President Xi Jinping's speech on February 14, 2020, he Policy Guidance reinforced the importance for local authorities and departments to apply digital technology in strengthening the epidemic responses. This reinforcement laid a solid foundation for promoting the in-depth application of digital technology in epidemic prevention and control. Government During the outbreak, the Chinese government continued to proceed with various prevention and control measures to ensure the smooth implementation of the digital technology. For example, the National Ground Support Health Security Administration and the National Health Commission issued relevant guidelines at the end of February, announcing that the "Internet Plus" follow-up services for common and chronic diseases were to be included in the scope of medical insurance payment.

In recent years, many cities in China are exploring the establishment Foundation of of medical information systems. In the process of participating in the Information fight against Covid-19, many medical technology companies, such as System We Doctor, United Imaging, rebuilt and connected original information Development systems, and effectively ensured the rapid successful implementation of the digital solutions. Social Since China entered the Internet era at the beginning of the 21st century, digital technology has been used in many aspects of society, such as social media, ecommerce, and mobile payment. This User Trust development become the foundation for digital technology to quickly obtain user participation and cooperation during the fight against Covid-19.

Faced with the evolving outbreak situation, many Chinese technology companies have reacted quickly. Enterprise leaders immediately Quick Decision- mobilized their employees to fight against the epidemic, and many Making and Input companies donated much resources such as hardware equipment and software technologies, unconditionally to facilitate the rapid spread and support the overwhelmed health system. Enterprise Technology accumulation is an important success factor for many technology companies when providing digital solutions for combating Covid-19. In the event of a public health emergency, in order to ensure Technology that various types of digital technology can be applied rapidly and Accumulation effectively to support prevention and control measures, the company's own accumulation of technology and application experience become critical.

Table 3. Key success factors at various levels

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and equipment construction, to • Third, innovative leading technologies technology implementation, data still need further improvement and integration and many more, all require optimization. Though technology has high-level coordination and contributed to many aspects of management. Throughout the epidemic prevention and control pandemic, public support of private measures, there still requires innovation sector players was instrumental to rapid in the applications and refinement upon implement and execute epidemic applications. Whether it is using artificial responses. intelligence, big data and other technology enabled solutions, Although China has integrated digital technology is expected to continue to technology into its Covid-19 response, play an integral role in many aspects of there are still areas that require further our daily lives. There is much untapped refinement and improvement: potential to be discovered.

• First, there is still a gap in public • Finally, the value of innovation in awareness and education in technology. payment and pricing mechanisms needs In China, the gaps in digital to be recognized. During this digital infrastructure across different regions enabled epidemic response, many has led to much disparity in terms of companies have contributed technology readiness and acceptance considerable funding, equipment, and in different populations of users. In addition, many elderly population against the devastating virus. Some groups and or people in lower income companies supported, even though they level tend to have less knowledge of knew there would be sizable capital cutting-edge technology and are less shortage. Therefore, how to establish willing to trust or accept local reasonable financial mechanisms to implementation of digital technology mitigate potential business impact on solutions. the technology companies while they continue to fight against the devastating • Second, data sharing and connectivity outbreak, still needs to be explored. need to be strengthened. Although the public opinion system has been established in China since the 2003 SARS epidemic, the data from across all governmental departments have not been fully integrated. As a result, in the event of state emergencies, there is insufficient aggregated data to support the government in making scientific, comprehensively informed and timely decisions.

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 138 Endnotes

WHO. (2020). WHO Director-General's Guan. YQ. (2020). Protection management opening remarks at the media briefing on of medical staff in CT room during Covid-19 - 1 July 2020. Available at: prevention and control in COVID-19. https://www.who.int/dg/speeches/detail/w International Infectious Diseases ho-director-general-s-opening-remarks-at- (Electronic Edition), 9(2):360-361. the-media-briefing-on-covid-19---1-july- 2020. [Accessed on 10th July]. Zhiyan Consulting. (2017). Development trend of China's Artificial Intelligence and The State Council Information Office of Medical Imaging in 2017 the People's Republic of China. (2020). Fighting Covid-19: China in Action. Available at: . Available at: http://www.scio.gov.cn/ztk/dtzt/42313/431 https://baike.baidu.com/item/百度地图 th 42/index.htm. [Accessed on 10th July]. /3702797?fr=aladdin. [Accessed on 28 June]. Zhu H., Shi W., Liu L., et al (2020). Experiences and Thoughts on Guangdong Medical Team supporting Honghu County to Combat Covid-19[J/OL]. China Medical Journal,2020,100 (2020-03-11).

Xiang H., Gu Y., Gong M., et al (2020) Our experiences about combating Convid-19 in epidemic area[N]. The Health Industry, 2020-03-06.

Gong, M., Liu, L., Sun, X., Yang, Y., Wang, S., & Zhu, H. (2020). Cloud-Based System for Effective Surveillance and Control of COVID-19: Useful Experiences from Hubei, China. Journal of medical Internet research, 22(4), e18948.

Yang, Z., Zeng, Z., Wang, K., Wong, S. S., Liang, W., Zanin, M., ... & Liang, J. (2020). Modified SEIR and AI prediction of the epidemics trend of COVID-19 in China under public health interventions. Journal of Thoracic Disease, 12(3), 165.

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 139 Author Team

Hanwen (Hava) ZHANG Sheng (Shawn) GU

Hava is a research and consulting project Shawn was responsible for knowledge manager. She led the integrated care management and communications. He led project funded by WHO. She is one of the the project to publish the Chinese version co-authors in "Improving Orphan Drug of Every Second Counts in 2018, a book Accessibility in China", and "Value-based innovation. He also joined several research in 2018 and 2019, respectively. Her projects with the roles such as researcher, research interests include innovative care coordinator, and communications service, value-based healthcare, orphan specialist. He has great passion in health drug accessibility, and etc. service innovation and health technology assessment.

Zhe YU Ta Ting (Tina) JA Zhe is a research and consulting project manager. The projects she worked on Tina is the Chief People officer and include Public Health Policy Research in External Partnerships Director for the -Sahara Countries China office, with a focus on organization commissioned by Sun Yat-Sen University building, people development, and - advisors and industry partners engagements. She works closely with our Research Foundation. Before joining the operations team to help refine organization, she worked as program organization structure and support people manager in charitable foundations and development. She also establishes marketing agency. relationships with key advisors and engage

projects have sufficient support. She holds an MBA from Tsinghua-MIT Sloan and

Human Biology and Economics from the University of Toronto.

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 140 Advisory & Supporting Team

Advisory Team Supporting Team

Dr. Chang LIU Yiling (Elin) SHI

Regional Director for Greater China and Undergraduate, New York University Southeast Asia, ACCESS Health Shanghai International

Jasmine SU Linguo LI Public Health Modelling Masters, Yale Senior Advisor, ASK Health School of Public Health

Ya Yuan (Rachel) LEUNG

MBChB, The Chinese University of

Yao TANG

Undergraduate, Xiang Ya Nursing School of Central South University

THE ROCKEFELLER FOUNDATION TACKLING COVID-19 PANDEMIC THROUGH INTEGRATING DIGITAL TECHNOLOGY AND PUBLIC HEALTH 141 rockefellerfoundation.org accessh.org