Background
Nepal Research and Education Network’s (NREN) along with other technology, medical, and development domain partners developed the COVID-19 Surveillance System to respond to the SARS-CoV-2 global pandemic. The team is cognizant that the global mobile app market has been flooded by a plethora of mobile/web apps and digital tools, which provide health advisories based on varying assessment parameters. However, Nepal’s requirements and ground realities behoove that a full stack response system be implemented to effectively counter a fast moving and potential epidemiological disaster.
Motivation
Since SARS-CoV-2 infections are gradually increasing in Nepal, this system will help flatten the infection curve, allow for social distancing, and provide patient information to medical professionals while avoiding institutional visits. The last factor can potentially mitigate the further spread of infections at hospitals during triage and give sufficient lead time for hospitals to prepare intake of a CoV-2 suspect patient.
Core Services
The C19SS delivers the following services:
- Self-triage of Covid-19 symptoms
- 24/7 monitoring of registered patients
- Geo-location tracking of patients
- Ambulance service/testing for necessary cases
- Assist developing GIS based containment zones
The NC19SS is based on “Emergency Healthcare COVID-19 Triage Scale” based on the data available through “25 International Expert WHO Team Finding of Covid-19 Symptoms in China”.
The NC19SS Self-Triage is designed for users to evaluate their COVID-19 related symptoms and it suggests further action to prevent deterioration of patient health and community transmission. The patient responses are fed into the system’s algorithm which generates a COVID-19 scale, which is further demarcated into “Least Likely, Less Likely, Likely if Travel and Contact history present, Highly likely” color coded divisions.
User responses are filtered and sorted based on severity, travel history, geo-location, and other health/history/behavioral indictors. Additionally, recent travel history patients are given special attention by the system. The Covid-19 suspect individual is provided with online/voice consultation and “High Probability” cases are referred to Nepal’s nationally mandated Covid-19 Hub Hospitals.
Only those users whose collective symptoms cross the threshold are allowed to register themselves. The initial user registration triggers an actual phone call by the 24/7 on-duty physician to further verify the potential suspect patient’s medical history, symptoms, etc. The physician suggests self-quarantine at home depending on patient condition. However, if their health condition seems worse than initially entered or if they have used the ‘Emergency Note’ option, then further necessary remedial medical intervention is initiated. This may include residential Swab Collection, Ambulance Service, in-depth case history review with other physicians, coordination with Covid-19 Hub Hospitals, etc.
Hence, the system consists of Self-Assessment Triage, it is standing on a full scale medical healthcare delivery platform that is customized to respond to SARS-CoV-2 virus testing, and treatment.
This app will also allow municipalities to track infection hot-spots and allow them to take containment decisions with precision and alacrity. The Covid-19 Surveillance System is more than just another health assessment mobile app and is part of the fight against Covid19 in resource limited settings and essential in prevention of a pandemic.
Endorsement
This C19SS is being reviewed by Nepal Health Research Council (NHRC), while Kathmandu Metropolitan City and Kathmandu Valley Mayors Forum are also in the process of formal endorsement of the surveillance system.
Implemented Region
Kathmandu Metropolitan City (KMC) along with all the Kathmandu Valley Municipalities, Mandandeupur Municipality, and Dullu Municipality (Karnali Province) have spearheaded the Covid19 Response by adopting and implementing the C19SS in their respective administrative boundaries. The primary reason for these local governments to encourage large scale usage by their residents of C19SS is to ensure prevention and mitigation of Covid19 at the community level.
Current Scope
The C19SS mobile app is accessible through Play Store/AppGallery – “Nepal COVID-19 Surveillance”. While the Self-Triage is available globally to any user, the subsequent User Registration Section can only be accessed by Kathmandu Valley residents, which avails them of the full stack of medical services.
Partners
- Nepal Research and Education Network (NREN)
- Innovative Solution Pvt. Ltd.
- i Click. Pvt. Ltd.
- Public Health Concern Trust-Nepal (PHECT-Nepal)
- Nepal Disaster and Emergency Medicine Center (NADEM)
- Innovative Data Solution Pvt. Ltd. (IDS)
- Center for Information and Communication Technology for Development (ICT4D)
