Various tech-driven initiatives have consolidated collection, organization and appraisal of global COVID-19 data. For example, a US-based consortium has created the COVID-19 Open Research Dataset (CORD-19), a digital archive with 128 000 scholarly articles on COVID-19, of which 59 000 are full-text articles. Furthermore, some leading academic centres have leveraged data sharing and tech-based epidemiological tools to appraise this literature, including Massachusetts General Hospital Fast Literature Update ('FLARE') and Johns Hopkins University Compendium (www. ncrc.jhsph.edu). These resources have dammed the tidal wave of information into manageable streams that are comprehensive, easily accessible and authoritative.
• Dissemination of information now occurs at unprecedented speed
Given that 70% of the global population uses mobile phones, medical information can now travel to billions of people within seconds. Social media (e.g. Twitter and Facebook), networking platforms (e.g. Doximity and LinkedIn), podcasts and journal news alerts touch almost everyone. Furthermore, many journals allow free access to COVID-19 material, boosting readership. While some use similar avenues to spread misinformation, leading to public misperceptions of brain death 2 and ventilator management in COVID-19, 3 the technology also encourages proper checks and balances via rapid corrections by global fact-checkers. Clinicians on the front lines thus find themselves well equipped with high-quality evidence that is readily available.
• 'Virtual Symposia' have revolutionized idea sharing Given the exponential adoption of Zoom, Skype and other multi-presence platforms, conferences are well attended and quick to assemble. Instead of waiting for yearly conference cycles requiring travel, virtual conferences now occur on demand. Recently, we virtually hosted a prominent critical care expert, who led a discussion of new COVID-19 findings 4 from his home in China, of the early Wuhan experience to hundreds of interested attendees from across the world. Similarly, expert panels organize with alacrity, with new global consensus statements available often within weeks rather than months or years.
• Telemedicine has amplified direct care and medical education through 'virtual learning'
With current videoconferencing technology, pointof-care clinical evaluation and treatment is possible through mobile phones and devices without travelling, benefiting those with limited means. Clinicians unable to attend patients in person (due to disability, retiree status and/or risk of contracting COVID-19) may still participate in direct patient care via the telemedicine interface. Supporting such efforts, a global call to action embracing telemedicine has been made. 5 Virtual learning allows medical providers to fill knowledge gaps and develop clinical confidence. For example, our UCSD telemedicine outreach initiative to rural hospitals battling COVID-19 facilitates joint telemedicine sessions with medical trainees and attending physicians, through which trainees appreciate varying medical approaches in resource-limited settings, learn the various determinants of local medical cultures and develop effective communication strategies in different contexts. Furthermore, shared telemedicine screens facilitate immersion in specific aspects of clinical evaluation, such as detailed ventilator waveform analysis in real time, which is not always possible in person.
• Novel data analytics stratifies risk of disease in real time
Machine learning (ML) and deep learning are analytical techniques with rising applications in clinical medicine given enhanced outcome predictions 6,7 based on physiological perturbations that are commonly overlooked. Diagnosis and triage of patients with COVID-19 with ML currently involve advanced image analyses 8 and methods previously used in predicting sepsis. 9 As data become increasingly fungible through HL-7/ FHIR (Health Level 7/Fast Healthcare Interoperability Resources) streams, integration of disparate clinical (e. g. laboratory data, imaging findings, co-morbid conditions, etc.) and non-clinical (e.g. demographic and environmental) information into common data models will grow further. ML-based algorithms can then stratify such data in real time and generate longitudinal risk scores of contracting serious illness. Furthermore, advanced methods such as temporal difference learning and credit assignment may show even more value in complex data environments often corresponding to human disease and behaviour. With such information, clinicians and public health agencies can better target therapies and track responses to achieve clinical and cost-effective benefits.
• Clinical trials are now being launched and conducted in record time to advance medical science Given the ubiquity of email, secure portals, online consents and other electronic methods over manual processes, researchers now conduct clinical trials with increased speed. Indeed, the World Health Organization (WHO) database now lists 1346 active COVID-19 trials underway. 10 As a result, recruitment, enrolment and statistical analysis are no longer rate-limiting steps, and clinical trials can effectively inform providers about efficacy and safety of novel therapies.
In the information age, technology-based solutions are increasingly powerful weapons in the war against COVID-19. Clinicians leverage technology not only via enhanced data analysis and telemedicine, but also by accelerating clinical trial execution that can broaden medical knowledge.
Future technological directions include development of real-time patient registries that facilitate prospective observational cohort studies, implementation science that empowers clinicians to eliminate errors and enhance utilization of existing tools and virtual consults that deliver specialized expertise to under-resourced areas. The unprecedented nature of the COVID pandemic has demanded novel and creative embracement of technology that we hope will persist. 