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International Innovative Approaches: Hospitals, Technology and Personal Protective Equipment

Innovative Approaches and Successes at International Hospitals

• At Cotugno Hospital in Naples, Italy, no health care worker has been infected. This infectious disease hospital has established strict infection prevention controls that go beyond appropriate personal protective equipment (PPE).
• The UK NHS has built seven COVID-19 hospitals, named Nightingale after Florence Nightingale, across England to handle a surge of COVID-19 patients. With fewer cases across the country, some of the Nightingale hospitals have been converted into cancer screening centres open 7 days a week.  
• A respite centre is being created for local NHS staff responding to the COVID-19 pandemic. The safe space will offer staff a place to have a nap, eat and drink and psychological support.
• The Division of General Surgery at the University of Washington Department of Surgery in Seattle has designed and implemented an emergency restructuring of the facility's general surgery resident care teams to optimize workforce well-being, comply with physical distancing requirements, and continue providing patient care.
• France is using its high-speed train (TGV) to transport patients from Paris to hospitals in other parts of the country that have more capacity. 
• The UK NHS has converted a former military hospital into a dedicated COVID-19 rehabilitation facility. The Seacole Centre will care for patients recovering from COVID-19 who have been discharged from acute care.  

Technological Solutions

Patient Screening and Tracking Solutions

• Wuhan turned a field hospital into a "Smart Hospital" introducing CloudMinds robots to a field hospital to care for patients, deliver food, and clean the facilities. An AI platform linked to smart rings and bracelets tracking patient vital signs allowed clinicians to monitor them remotely.
• University California San Francisco TemPredict Study will use the activity tracker ring Oura to collect physiological data in attempt to detect early COVID-19 symptoms in healthcare workers.
• Biofourmis has developed a remote monitoring and disease surveillance program in Hong Kong for patients with diagnosed or suspected COVID-19. Physiological changes will be tracked on a clinician-facing dashboard so adverse events trigger more rapid intervention.
• Singapore has enabled temperature screening AI technology in its hospitals.

• Tampa General Hospital in Florida has implemented an AI-powered screening system developed by Orlando-based Care.ai Inc. that includes a thermal scanner to detect fevers in people entering the facility.
• Stanford clinicians are validating the Deterioration Index, built by Epic (the EHR vendor), which has been updated for COVID-19 patients. The index analyzes hospitalized patient data to trigger escalated care or transfer to ICU, freeing clinicians from constant monitoring and chart reading.
• Zhongnan Hospital of Wuhan University, used AI to detect signs of pneumonia in lung CT scans in order to more rapidly identify and prioritize patients for examination and testing.
• A hospital in the UK has partnered with Babylon Health to deliver COVID-19 Care Assistant app to all staff and patients registered to the hospital. Patients can track their symptoms and chat with clinicians.
• Singapore is using technology to speed up contact tracing:   
• SafeEntry- a digital check-in/check-out system to log the visits by individuals in all business premises and venues.  
• TraceTogether app- uses Bluetooth on phones to quickly identify whom a person has been near to, to facilitate contract tracing when the need arises. 
• Australia launched a voluntary app, called COVIDSafe, to speed up contact tracing. 
• Alberta is using the ABTraceTogether App, which uses Bluetooth, to facilitate contact tracing. Other provinces are considering contact tracing apps.  
• Covid Watch uses Bluetooth to allow people who tested positive to anonymously alert others who they may have unknowingly infected. 
• Sunnybrook Health Sciences launched COVIDEO, a new way to support patients with mild to moderate COVID symptoms at home.  
• University of Pennsylvania Health System developed an automated text-messaging remote monitoring system, called COVID Watch, for patients with confirmed or suspected COVID-19. Combined with a 24/7 clinical back end, the program is designed to and rapidly connect patients by phone with a clinician and escalate care when needed. 

Predictive Solutions

• Researchers at Columbia University and two hospitals in Wenzou, China have developed a model to predict whether patients will go on to develop acute respiratory distress syndrome (ARDS). The published model currently achieves 70-80% accuracy in predicting severe cases.
• Two new field ICU hospitals in Israel are using CLEWICU, a predictive analytics telemedicine platform that can identify symptom deterioration in advance. Clinicians can proactively monitor patients remotely from a command centre, reducing patient contact but allowing for early intervention.
• Researchers at NYU Grossman School of Medicine and NYU's Courant Institute of Mathematical Sciences, in partnership with Wenzhou Central Hospital and Cangnan People's Hospital (both in Wenzhou, China) have developed an AI tool that has been shown to predict with 80% accuracy when patients newly infected with COVID-19 would go on to develop acute respiratory distress syndrome (ARDS).

New Approaches to Testing

• The US Food and Drug Administration (FDA) gave emergency use authorization to a saliva-based test that showed similar efficacy to nasopharyngeal swabs.
• A recent pre-print study also suggests that saliva samples may be as effective as nasopharyngeal swabs in detecting the virus that causes COVID-19.  In comparison to nasopharyngeal swabs, saliva samples can be self-collected, are less invasive, do not pose as great a risk to health care workers, do not require airborne PPE precautions, and lower demand for swabs.

• An emergency use authorization has been granted by the FDA for the first at-home COVID-19 test produced by LabCorp. The test kit uses a specific Q-tip-style cotton nose swab and relies on the purchaser to return the sample swab to LabCorp for processing.
• A rapid COVID-19 test that relies on CRISPR, a technology that can detect a predefined coronavirus sequence, has been granted an emergency use authorization by the FDA. In comparison to the standard RT-PCR which takes six hours, the CRISPR test takes about 40 minutes. 
• 3M and researchers from MIT are working to develop a fast COVID-19 test that would be paper-based and could be mass produced. While less sensitive than laboratory-based tests, the test would be cheap, less invasive, and provide results within minutes. A paper strip, embedded with a strip of protein, is inserted into a tube of saliva and will change colour within 15 minutes if the saliva contains enough virus.  
• Researchers at University of Windsor are developing a portable device called, Lab-on-a-Chip, to test and diagnose patients at the point-of-care. The device would be faster, cheaper and more accurate than laboratory-based tests. 

PPE Innovation  

• A Taiwanese doctor has released design plans for an aerosol box that can be used to reduced droplet contamination during endotracheal intubation. 
• In a letter to the editor in the New England Journal of Medicine, clinicians in Boston found that the box provided additional protection to clinicians performing intubation procedures. 
• Klick Health in partnership with Humber River Hospital is providing free boxes to hospitals. 
• JAMA put out a general call for ideas to conserve PPE supply. Responses from medical community include processes to clean and reuse PPE and alternatives to traditional PPE. 
• Snorkel masks were suggested as an alternative to surgical masks and eye protection. European researchers are currently testing retrofitted snorkel masks as an alternative to N95/FFP3 respirators. 
• Italy and other jurisdictions are adapting snorkeling masks that can be used if hospitals face a shortage of C-PAP masks. 

Other Solutions

• China, US and Europe are using robots to sanitize hospitals and monitor patients.
• Stanford is estimating unreported COVID-19 infections with viral-genome data, automating contact-tracing with Bluetooth technology and analyzing Twitter for mental-health impacts.
• The Medical Futurist Institute has created a handbook as a short summary of technological efforts fighting COVID-19 worldwide.

• The Ministry of Health in British Columbia and the Provincial Health Officer partnered with Appnovation to collect staffing data of HCWs that work at multiple site, which enables the identification of hot spots within health care facilities and decision-making about resourcing. 
• A team from the University of Toronto has developed a remote monitoring device that allows health care workers to continuously monitor patients' vital signs. The device may help conserve PPE because health care workers can avoid going into hospital rooms.
• A team of oncologists and data scientists in Michigan have developed a free app called OncCOVID, that helps physicians compare the risk to cancer patients from postponement of care as well as the risk of undergoing treatment while potentially COVID-19 positive. 
• Jewish General Hospital in Montreal is using HoloLens, a mixed-reality platform, to transmit live video stream of a patient interaction to a computer screen nearby. The platform helps minimize interactions between patients and health care workers for infection control without compromising care.    
• Vituity, a California hospital system, has employed Hospital@Home, a 150-bed virtual hospital to care for patients with CHF, COPD, and COVID-19 in their own homes. The program includes 24/7 monitoring and access to providers, daily nursing team visits, and a rapid response team. 
• The IPAC team at Kingston Health Sciences Centre created the COVID-19 Ontario Prevalence Tool to assess the COVID-19 risk factor for patients undergoing elective surgery. The tool considers the patient's postal code to identify that area's case prevalence.