Mobile health technology combats COVID-19 in China.

China empowers mobile health technologies to fight against COVID-19 pandemic. The success of mobile health here may be a useful reference for other parts of the world. We explore China's application of mobile health technologies to replenishing traditional public-health and social approaches for mitigating and suppressing COVID-19, and found that Internet hospitals alleviate the unavailability, inaccessibility, and inequity of health services during the outbreak; the fact-check and information-release platforms reduce the spread of misinformation; and the infection risk scoring systems facilitate restoring the order of production and life.

To the Editor,

Recently, there have been some papers of coronavirus disease 2019 (COVID-19) reported in this journal, which focused on mobile health technologies. The COVID-19 pandemic has precipitated a global crisis due to the continued absence of a vaccine or cure, affecting more than 200 countries and areas, with more than 10 million confirmed cases and more than 0.5 million confirmed deaths globally by 4 July 2020. China is one of the countries that has contained COVID-19 propagation and almost stopped indigenous transmission. Mobile health, a comprehensive strategy that uses mobile apps, sensors, social media, and location tracking technologies to obtain medical data and to provide health services, played a major role in tackling COVID-19 epidemic. We explore China's application of three mobile health technologies to replenishing traditional public-health and social approaches for mitigating and suppressing COVID-19, including (1) Internet hospital, (2) fact-check and information-release platform, and (3) infection risk score (Fig. 1 ).

Fig. 1

Application of Mobile Health Technology in China during the COVID-19 epidemic and beyond. This figure presents a simplified view of the workflow of mobile health. The Internet of Things (IoT) communicates with the individual's smartphone via Bluetooth or Wi-Fi. The databases include household registration information, drug purchase records, medical records, travel history and other data. Once on the phone, those passive data combined with active data reported by individuals can be displayed in the app or can be sent up to the cloud storage. This cloud “backend” stores data and can apply artificial intelligence (AI) algorithms as well as big data analytic techniques to generate predictions, visualizations, or decision support. The cloud output can then be delivered back and displayed on a mobile phone app or website that is accessible to individuals and available to the relevant personnel after authorized. Internet hospitals provided telemedicine-based consultation and medication delivery services, and the cost can be reimbursed by medical insurance. The governments and health agencies partnered with social media companies to eliminate misinformation and to provide trustworthy information. The integration of active self-reported health status and passive background creates an infection risk score system, also known as health QR codes. Now citizens are required to hold a “green” code for entering public facilities, workplaces, schools, or traveling.

Internet hospitals alleviate the unavailability, inaccessibility, and inequity of health services during the outbreak. Health services had been overwhelmed by the rapid and widespread person-to-person transmission, and could not be accessed due to strict quarantine, isolation, and lockdown policies. Internet hospitals provided telemedicine-based consultation for both COVID-19 and common chronic diseases, psychological counseling, and health education via smartphone apps and hospitals’ official websites. This is a possible solution to delivering routine health care without COVID-19 exposure risk and to avoiding unnecessary hospital consultations for patients with mild flu symptoms. During the epidemic, the health services delivery by Internet hospital increased 17 times over the same period last year. From January 1 through April 30, 2020, a total of 146 Internet hospitals were launched, accounting for about 30% of the total. Several innovations and collaborations empower Internet hospital to combat COVID-19. Artificial intelligence-aided online medical chatbots were employed to decrease physicians’ workloads and to enhance capabilities to triage suspected patients. Blockchain companies and pharmacies were cooperated with Internet hospitals to deliver prescription drugs to patients' doorsteps. A large number of doctors, including medical students, newly registered at Internet hospitals, provided voluntary consultations and addressed public inquiries. The authorities issued regulations requiring that eligible "Internet+" medical service fees be covered in medical insurance payments.

Fact-check and information-release platforms reduce the spread of misinformation. We're not just fighting an epidemic; we're fighting an infodemic. Digital social networks play an unprecedented role in health information communication because of physical distancing and near-complete global lockdown. Users in the self-media era increasingly see influencers within their peer networks as trustworthy sources of information. However, this method lacks expertise and responsibilities related to information inspection and dissemination, thus fostering the spread of misinformation which destabilizes public trust and further imperil public health. The Chinese governments and health bodies cooperated with social media giants Sina, and Tencent to take action to eliminate misinformation, such as flagging, fact-checking, and even removing false or outdated information, and to provide trustworthy sources of ongoing updates for COVID-19 about transmission, diagnosis, treatment, and policies. The fact-check and information-release platforms leverage their efforts to flatten the curve of misinformation and to elevate facts over fiction so as to not incite panic amongst the public.

The infection risk scoring systems facilitate restoring the order of production and life. While the outbreak continues to ease, work and production resumption has been a key priority in China. The national government service platform and the local governments combined history of individuals’ locations, medical information, and medication purchase records to create infection risk scoring systems, what is called the health QR codes, embedded in widely used apps such as Alipay and WeChat. The health QR codes are generally divided into three colors: green, yellow, and red. Yellow or red indicates that the resident has not passed the health check because of one of the following reasons with 14 days: fever clinic visits records, fever-reducing drugs purchase records, travel history in high-risk regions, close contacts of confirmed or suspected cases, or physical symptoms when filling in an application form. Now citizens are required to have a “green” code when entering public facilities, workplaces, or traveling. Active voluntarily self-reported data on health status via daily one-minute surveys complement passive background-based health QR codes. Besides, coronavirus nucleic acid detection and paper certificates were used as supplementary measures for those uncertain residents. The use of the health QR codes have overcome the fragmentation of traditional data collection and greatly promoted the government's precise measures in epidemic prevention and control and resumption of work and production in an orderly fashion.

Although the mobile health technology-enabled approaches will definitely play an unprecedented role during and after the COVID-19 pandemic, we still need to pay attention to their potential limitations, including intergenerational differences in smart devices ownership and the digital divide in media access. Digital refugees are groups that are far from digital technologies due to economic, social, and cultural reasons. Mobile health is based on smartphones, but nearly 40% of Chinese are not mobile Internet users, including two categories: owning a mobile phone but not surfing the Internet, and not owning a mobile phone. In the process of digitization, we must consider that these digital refugees, such as the elderly, provide them with alternative solutions so that they will not be left by mobile health.

CRediT authorship contribution statement

Jieyu Wu: Writing - original draft, Writing - review & editing. Xiaowei Xie: Writing - original draft, Writing - review & editing. Le Yang: Writing - review & editing. Xingyan Xu: Writing - review & editing. Yingying Cai: Writing - review & editing. Tinggui Wang: Writing - review & editing. Xiaoxu Xie: Writing - original draft, Writing - review & editing.

Declaration of Competing Interest

All authors declare that there are no conflicts of interest.