This abstract was submitted to and presented at CCRC International Conference 2022.

Global Health Screening & Tracking Initiative
Clifton R. Lacy, MD, David L. Turock, PhD, Warren S. Gifford, PhD; Great Plain
Technologies, LLC, USA. Corresponding Author: Warren S. Gifford
Goals of This Paper
To describe• the feasibility of a health screening system based on mobile devices• the desirability of deploying this system on a global scale• the opportunities to participate, support, and help lead this initiative.
Background
Critically important for public health in general, and in the case of COVID-19 in particular,
are health screening and tracking methods to detect disease early enough to minimize its
spread, to identify correctly the illness and its cause, to identify known and emerging signs
and symptoms, and to evaluate the effectiveness of preventive measures and treatments.
SCREENING FOR COVID-19
Elliott et al (2021)1 showed that impaired Smell and Taste were very strong predictors of
COVID-19, Figure 1.
Impairment of sense of smell and taste are not only excellent predictors of COVID-19 but
also temporally precede onset of fever and other conventional signs and symptoms ofrespiratory illness.
Figure 1
Typically, infection bySARS-CoV-2, thecausative organism of
COVID-19, begins in thenasopharynx, frequently
produces disturbance oftaste and smell (likely dueto damage tosustentacular cells, the7 Most Predictive Signs & Symptoms of COVID-19
Impaired Smell
Impaired TasteFever
New Persistent CoughChills
Appetite Loss
Severe Fatigue

cells that support andOdds Ratio 1
10100
assist the olfactoryneurons), then spreads to infect the lungs and other parts of the body, triggering a more robust

1Elliott, J., Whitaker, M., Bodinier, B., Eales, O., Riley, S., Ward, H., Cooke, G., Darzi, A., Chadeau-Hyam, M.,& Elliott, P., (2021, September, 28), Predictive symptoms for COVID-19 in the community: REACT-1 study ofover 1 million people, PLOS Medicine, https://doi.org/10.1371/journal.pmed.1003777
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immune response, and producing a variety of signs and symptoms as a consequence of both
infection and immune reaction, Figure 2.
Figure 2A smell or taste stimulus will normally cause pupils todilate via activation of the autonomic nervous system.
The Pupillary Response to Olfactory Stimuli system,
PROS2, measures that dilation using a mobile device,
Figure 3.
To prevent spread of COVID-19, screening should

Smell & Taste vs. Fever & CoughLikelihood
100%

Impaired
Smell &Taste
Fever &

ideally be performed daily before interaction with others
Coughin public or in the home. PROS screening can be done by0%
DelayDays
anyone with access to an Internet connected mobiledevice, wherever they are, and for free. The results are objective, so no interpretation by theindividual is needed. If PROS indicates the possibility of COVID-19, the individual can
immediately take measures to prevent spread, such as masking, self-quarantine and obtaining
definitive nucleic acid amplification testing.
Some people have impaired sense of taste or smell for other reasons, including age, nasal
congestion, and neuro-degenerative diseases, among others. To recognize the rapid onset ofsmell and/or taste
disturbance which ischaracteristic of asignificant subset ofpeople withFigure 3
Pupil Response to Olfactory Stimuli, the PROS SystemStimuli
Pupil
Dilation
Tracking

COVID-19, PROS
uses the record ofprior measurements
to create a personal
baseline and track
measurements overCamera
Instructions
Tracking
Distractions• Stimuli

Mobile Device

SmellTaste• Responses
time.
• Measurements
Long-Covid
A meta-study3 showed “5 of 10 survivors of COVID-19 developed a broad array ofpulmonary and extrapulmonary clinical manifestations, including nervous system and2Lacy, C. R., Gifford, W. S., & Turock, D. L., (2021, February, 4), Systems and methods for screening subjects

based on pupillary response to olfactory stimulation, U.S. Patent No. 11,083,405
3Groff, D., Sun, A., Ssentongo, A. E., Ba, D. M., Parsons, N., Poudel, G. R., Lekoubou, A., Oh, J. S., Ericson, J.

E., Ssentongo, P. & Chinchilli, V. M., (2021, October, 18), Short-term and Long-term Rates of Post-Acute
Sequelae of SARS-CoV-2 Infection A Systematic Review, JAMA Network Open. 2021;4(10):e2128568.
https://doi.org:10.1001/jamanetworkopen.2021.28568
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neurocognitive disorders, mental health disorders, cardiovascular disorders, gastrointestinal
disorders, skin disorders, and signs and symptoms related to poor general well-being,
including malaise, fatigue, musculoskeletal pain, and reduced quality of life.”.
In addition, the authors concluded that, “… clinical management will require a whole-patientperspective. … many individuals experience disability, greatly exacerbating the disease
burden. Such a burden is more than enough to overwhelm existing health care system
capacities, particularly in resource-constrained settings.”
Screening for Long-Covid
Not all individuals who contract COVID-19 experience impaired senses of smell or taste. For
these cases, and to help distinguish COVID-19 from other potential causes, additional
screening methods are needed.
Many people with Long-COVID complain of “brain fog” – disturbances in thinking, memory,
and/or concentration. There are no widely used tests for this condition. Brain fog can also be
a sign of other diseases and conditions, such as Chronic Fatigue Syndrome, Lyme disease,etc.
The Cognitive Ocular Neuro Stimulation system, CONS4, Figure 4, is a method to detect
disease-related changes in response to a battery of mobile device-based neuro-physiologicalchallenges.
The individual
performs a varietyof tasks, such as
connecting dots innumerical andalphabetical order(Trail-Making), ortapping on objects
displayed on thescreen according

Figure 4
Cognitive Ocular Neuro Stimulation, the CONS System
Stimuli
Position
Pupil
Dilation
Tracking

Eye Motion

ImagesSoundsInstructions• Stimuli• Responses• Measurements

Distractions

Accuracy

TimingMotionto directions (Finger Tapping). The tasks are quick, and can even be fun, so people areencouraged to perform them regularly as part of screening. The tasks can be made morechallenging, and more discriminating, by varying the tasks and by providing distractions.
These tests can detect and distinguish a wide variety of neuro-physiological changes.
The list of recognized signs and symptoms of COVID-19 is long and continues togrow. Many other diseases and conditions have findings that overlap with this list. We are
exploring incorporating additional objective tests to further improve accuracy of screening
4Lacy, C. R., Gifford, W. S., & Turock, D. L., (2021, November, 17), Systems and methods for screening

subjects for neuropathology associated with a condition utilizing a mobile device, U.S. Patent Application No.
17/528,417
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for COVID-19, and to distinguish and differentiate between COVID-19 and other diseases
and conditions.
PROPOSED HEALTH SCREENING & TRACKING SYSTEM
The proposed health screening system is easy to use, Figure 5. The mobile device app can
automatically recognize an existing user based on screening characteristics. The user’s profileand history guide which screening test to run Figure 5
first in the session. Based on the results, theGlobal Health Screen & Tracking System, Individual
session continues with additional screening
procedures, including objective tests (suchas PROS and CONS) and subjective
questions on the user’s current status andrecent events. At the end of the session,
based on the individual’s responses, thesystem may issue an alert suggesting theuser seek medical attention and take otheractions such as self-quarantine, masking,and definitive testing.

Access &Management
Screening
Screening

AlertsScreening
AppHealthSystem

The system can be configured to send secure
information about the user to authorized
health workers to assist in supporting theuser. This detailed health information helps
health workers better support the user andSubject
Data

Secure- Identification- Data Access- Communications

saves time in repeating tests. Health workers can enter data into the system, such as test
results and diagnoses. This data can improve the screening process, for example, bycomparing screening results with corresponding test results.
Maintaining privacy and security of this information is essential. The system provides anumber of secure services, including user identification, data access, and communications.
A key feature of these secure services is the ability for the user to access and manage theservices. The companion paper, Global Health Data with Trust, provides details on these andother aspects of the system.
The proposed Global Health Screening & Tracking system can provide the comprehensive
data and documentation to support comprehensive health care.
Analysis & Research
One of the key challenges encountered in the COVID-19 pandemic is differentiating between
the signs and symptoms of COVID-19 and similarly-presenting diseases.
The data collected by the Global Health Screening and Tracking System can be invaluable inmonitoring the detection, characterization, and evolution of signs and symptoms of disease.
This system’s support of analysis and research aids in advancing understanding of the many
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aspects of COVID-19, and its similarity, dissimilarity, and relationship to other diseases andconditions, Figure 6.
Use of de-identified data enables
individual and group comparisons andstructured evaluations of alternative
tests and protocols to improve theeffectiveness of screening, publichealth measures, and treatments.
These results enable determination of“best practices” to be deployed in thescreening system. They also provide
comprehensive, objective, timely data
to policy makers, public health andhealth care workers, and the generalpublic. This is a unique opportunity toprovide not only information andperspective, but also to promote

Figure 6

Global Health Screening & Tracking System, Management
Access &Management
Screening

AlertsScreening
AppBest Practices
Protocol Testing

Subject
Data

Secure- Identification- Data Access- Communications

Research &Analysis

PublicInformation

learning and education to stimulateinterest in better understanding ofhealth and disease. Perhaps this can become a stimulus for a whole generation of youth to get
excited about science and health – much as the space race influenced our generation.
The system also enables research; for example, using the database and communications
features to identify, recruit, track, and maintain research subjects.
Mechanisms to manage the analysis, research, and public information processes are describedin the companion paper, Global Health Data with Trust.
CONCLUSIONSThe COVID-19 global pandemic has clearly demonstrated the need for more frequent andmore detailed health screening to detect and identify illness and to allow individuals toprotect themselves and society. The pandemic has also clearly demonstrated the need formore accurate, detailed and extensive analysis and research of objective, validated data.
The Global Health Screening Initiative provides the tools to perform this essential screening.
The companion paper Global Health Data with Trust describes mechanisms to meet thesimultaneous mandates of personal privacy and data-intensive research.
This is an ambitious proposal from many perspectives. Hopefully the combination of
personal and social benefits will be sufficient impetus to drive toward implementation.
We are actively seeking partners to fund, build, and operate the initiative.

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