We are living in unprecedented times. COVID-19 has infected over 2,000,000 and killed almost 140,000 worldwide as of April 17th.
In the US alone, over 600,000 have the virus, and over 28,000 have lost their lives to the disease. This virus has plunged economies into recession, taken away lives, jobs, and left us completely isolated. To fight the virus, we need to do the opposite of our instincts. Instead of meeting up with friends and family or burying ourselves in our work, we must isolate ourselves. To fight this virus, we have to be alone.
A Global Wake-Up Call
Currently, we are not allowed to leave our homes except for essential activities. This has left all of us with a lot of time on our hands. The questions on everyone’s minds: how did this happen and will it happen again?
Ask any epidemiologist, the question we should be asking is not “will this happen again,” it is “when will this happen again” Pandemics have always been a part of human history. From deadly flu and cholera pandemics to the bubonic plague, pandemics have killed millions of people. To fight the next pandemic, we need to identify gaps in our public health activities.
Over the course of the COVID-19 pandemic, many gaps have surfaced. Low transparency and accuracy of data systems, a lack of interoperability between early-detection systems, and failing supply chains of response systems have all contributed to the severity of the outbreak. Fortunately, blockchain technology provides an elegant solution to many of these problems.
Failing Public Health Activities
Preventing and detecting new diseases that have pandemic potential is a major public health activity. Many surveillance systems track potential new diseases and control existing diseases. Unfortunately, many of these surveillance systems are outdated, hard to access, or inaccurate. Additionally, all of these surveillance systems are centralized, meaning access to data is restricted to a central authority. This lack of transparency was especially costly in the fight against COVID-19.
Decentralization and Transparency
In China, where COVID-19 originated, an early-detection system already exists. After the SARS coronavirus outbreak, officials identified a need for a better detection system. Now, that system is outdated and only accessible through the Chinese Ministry of Health.
Unfortunately, this centralized system does not allow for transparency of information. In fact, in China, early reports of COVID-19 were prosecuted. On December 30th, Dr. Li Wenliang issued a warning to his medical school classmates that there was a new virus emerging. Dr. Li was detained by police and told to sign a statement that he had participated in illegal behavior by issuing his warning. Dr. Li later died from COVID-19.
A blockchain disease surveillance system could have prevented these transparency issues. A decentralized system does not rely on a central authority to release and share information. With a blockchain solution, public health officials, governments, and health practitioners could all retain access to disease surveillance data. Commonly, a permissioned blockchain helps to protect sensitive data. Public health officials, health care practitioners, governments, morgues, testing centers, etc. would serve as nodes in the blockchain and could contribute to the ledger.
Such a system could create warnings automatically. When the system reaches an outbreak threshold, it will send warnings to all nodes. Then, prevention efforts could be organized and implemented earlier. When a system doesn’t rely on a centralized authority to decide when outside action is needed, help can intervene earlier.
The current infection and death statistics around the world are speculated to be much higher due to underreporting. Many hospitals only have access to a small number of testing kits, so patients are treated and either die or recover without being tested. Additionally, CDC guidelines tell the public to stay home if they are feeling sick and to only go to the hospital if they exhibit “emergency warning signs” such as trouble breathing. Although these regulations stop unnecessary burden on the healthcare system, they prevent public health officials from knowing how many cases are active. This information is vital for decisions surrounding stay at home orders, medical supply orders, and hospital capacity needs.
This lack of trustworthy data is a huge problem. It’s hard to trust the statistics when you don’t trust the authority which provides the data. This leads to public mistrust of governments and guidelines, even when they are necessary and based on accurate data. Transparency of information is especially important for pandemic efforts when the actions of the public have a huge impact on whether relief efforts are successful. For example, current social distancing guidelines are only effective if the public follows them. Recently, protests all over the country have occurred due to increased guidelines. In the COVID-19 outbreak, it’s obvious the public is losing trust in response decisions.
Blockchain is incredibly secure, and many industries already trust it to handle sensitive information. For example, some new electronic health record systems utilize blockchain technology to secure their health records. Because the ledger is immutable, every single change can be traced back to its origin. This means every data point can be trusted. Such a system could be available for public view. Then, citizens would have the same data officials are using to coordinate response efforts. As previously mentioned, the public has a large impact on whether guidelines such as stay at home orders are effective. With access to irrefutable data, it will be easier to obtain public support.
Securing Response Supply Chains
After an outbreak occurs, response systems are needed to fight the disease. These activities involve increasing healthcare capacity, ensuring enough Personal Protective Equipment (PPE) is available for healthcare workers, and ensuring therapies are available to treat the disease. During the COVID-19 response, all of these activities have failed.
Hospitals are overcapacity, PPE is running out, and there are not enough ventilators available. These problems are caused in part by supply chain management issues. In New York, hospitals are completely overwhelmed, while a Navy hospital ship sits largely empty. The federal government has created a strategic national stockpile of ventilators and PPE, but requesting and acquiring these resources has proved extremely difficult, leaving governors to compete against other states for the life-saving equipment they need. Additionally, some equipment that has arrived is faulty. This is catastrophic for relief efforts because hospitals are left waiting even longer for proper equipment. Many businesses and industries are retooling to create equipment that is needed. Clothing factories have been transformed into PPE factories, and many businesses are retooling to make ventilators. When businesses are making equipment they don’t usually make, supply chain management can be difficult.
Fortunately, blockchain is a proven supply-chain management tool. Correct allocation of resources is essential during a pandemic. Because the ledger is immutable, blockchain provides an easily traceable supply chain. Hospitals will be able to know that their equipment is accurate because they will be able to trace the supply chain back to the origin. Allocation of resources can occur more objectively between states because the system will rely on accurate data. This will allow officials to send the right equipment to the places where it is needed the most. Proper supply-chain management through blockchain will ensure relief efforts are efficient and effective.
Gaps in Prevention
Zoonotic diseases like COVID-19 originate in animals and then make the jump to humans. These viruses have the potential to be extremely contagious and extremely deadly because no one has any natural immunity. Most diseases that reach pandemic status are zoonotic. Preventing these outbreaks is a huge public health activity. Many field veterinarians are performing disease surveillance on animal populations to identify possible zoonotic diseases. A study identified that many animal health practitioners encountered zoonotic diseases in their practice. Many stated that zoonotic diseases often go unreported because there is no easy system in place. In fact, 70% of veterinarians reported that they had no access to a reporting system. Additionally, the study identified a gap in the integration of human and animal surveillance efforts. Currently, animal disease surveillance and human disease surveillance are not integrated. To prevent zoonotic diseases, we need a system that allows all health care practitioners access to both human and animal data.
Fortunately, blockchain provides a perfect solution. A permissioned blockchain will allow all healthcare practitioners to track emerging diseases. Once in the system, all practitioners will be able to access and use the data. The decentralized nature of the technology allows for increased transparency since no central authority is holding all of the information. Every clinic, no matter how small, can access the ledger through an application and add their data. Then, larger public health efforts can use the data to target and prevent future outbreaks. This is especially useful in cases where migratory animals spread disease. One decentralized system allows increased transparency and an increase in the number of accurate data points.
Diseases can spread quickly across political borders. Traditional systems run by governments can miss outbreaks because they happen across borders. A decentralized system is the fastest way to report outbreaks. With a blockchain healthcare surveillance system, local practitioners can receive real-time information on surrounding areas, regardless of governmental or political barriers. Increasing transparency will result in more accurate reporting and more efficient responses.
Such a system is relatively simple to implement. A blockchain application is low-cost and can be downloaded on any mobile device. Chief complaints and prescription data inputted to the system could trigger automated alerts when a certain threshold is reached. Additionally, laboratory test results can trigger an alert. Because blockchain is decentralized, it is extremely scalable. A global healthcare blockchain system could easily reach areas where connectivity is poor, and costs must be kept low.