key: cord-330104-wgo4pml6
authors: Farrugia, Gianrico; Plutowski, Roshelle W.
title: Innovation Lessons From the COVID-19 Pandemic
date: 2020-06-06
journal: Mayo Clin Proc
DOI: 10.1016/j.mayocp.2020.05.024
sha: 
doc_id: 330104
cord_uid: wgo4pml6

Abstract On December 31, 2019, Chinese authorities reported the first case of what would become known as COVID-19 to the World Health Organization (WHO), which declared a Public Health Emergency of International Concern one month later. In the ensuing weeks, health care organizations, industry partners, and government agencies worldwide have quickly come together to address pandemic challenges such as scaling high-quality laboratory tests, conducting treatment research, and enabling virtual health care in a time of social distancing. What we have accomplished together to date demonstrates the opportunity for future cross-sector partnerships in science and technology to fight the disease, while simultaneously creating the new digital health care solutions that our world greatly needs.

On December 31, 2019, Chinese authorities reported the first case of what would become known as COVID-19 to the World Health Organization (WHO), which declared a Public Health Emergency of International Concern one month later. 1 At the time of this publication, the virus has spread to all six WHO regions, infecting several million people and killing more than a 280,000 worldwide, with numbers that continue to grow. 2 To stem pandemic-related deaths and prevent health care systems from being overwhelmed with sick patients, governments responded by limiting travel, closing schools, issuing stay-at-home orders, making emergency investments in health care, scaling testing, and using data and technology to trace contacts. 3 In the interim, health care organizations ramped up molecular and serologic testing, initiated triage systems to reduce exposure, and prepared facilities and staff for a surge of COVID-19 cases. 4 To identify effective tools to fight the disease, biotech, pharma, IT, and academia quickly turned their attention and resources to research vaccines, antivirals, and immune response to the virus.

Now, a few months into the pandemic, people worldwide continue to suffer from both the health and economic fallout of COVID-19. As the crisis wears on and experts predict additional waves of infection, 5 we must strongly resist the natural urge to retreat to our safe zones to ride out the storm. Instead, we must seize the opportunity for cross-sector partnerships in science and technology to fight the disease, while simultaneously deploying new digital health care solutions that our world greatly needs. With science guiding every step, we must adopt an urgent, short-term strategy to save lives, but always with an eye toward the long-term.

Public-private partnership facilitates innovation, and we've seen significant collaboration from many levels of the U.S. government over the last months. We and other health care providers have advocated for many years for more flexibility in licensing and telehealth regulations to enable virtual care. The pandemic catalyzed these changes. The Federal Communications Commission (FCC) facilitated expanding access with The COVID-19 Telehealth Program, fasttracking application processes and funding to help health care providers quickly establish telehealth services for remote patients. 6 To date, the Centers for Medicare and Medicaid

Services has agreed to pay in-person visit rates for virtual visits for several office and hospital telehealth appointments with a variety of providers, including physicians, nurse practitioners, and psychologists. 7 To meet the demand for virtual services, Mayo Clinic has expanded video appointments from about 200 to 35,000 virtual visits per week. Many if not close to all other medical centers also are ramping up quickly. 8 Mayo Clinic patients' response to virtual care has been positive, and we intend to build on this model in the future -not to replace face-to-face visits but rather to increase patient convenience and make in-person care more efficient when needed. We also must ensure that the regulatory changes that have made virtual services scalable are refined but not rolled back.

The response to the pandemic has produced partnerships that are impressive in scale and that reimagine traditional organizational boundaries. One initiative, the COVID-19 Healthcare Coalition, has garnered the expertise and resources from large health care organizations, private industries, academic institutions, and startups. Coordinating the use of data and advanced analytics, the collaboration-which includes Mayo Clinic, the University of California Health Care System, Amazon Web Services, Microsoft, and Epic, among others -aims to flatten the infection and mortality curves, improve outcomes, and enable clinics and hospitals to continue to respond to patient needs. The initiative's guiding principles stipulate no participants receive pay or preferential advantage. 9 While international collaboration has long been common practice in research, the pandemic has shown the ability to achieve clinical results at an unprecedented pace through data sharing with trusted partners. Initiatives such as the Global Initiative on Sharing All Influenza Data, which gather sequenced viral COVID-19 genomes from labs all over the world, have proven to be essential open-access tools so investigators can learn more about the virus and its spread. 10

To study four potential COVID-19 therapeutics, a new international consortium of researchers rose up immediately to form the SOLIDARITY trial, which is being conducted in more than a dozen countries. 11 In addition, our collaborations have also enabled us to massively scale-up innovation. We have collaborated with investigators across the country to initiate a national effort to procure convalescent plasma from eligible donors who have recuperated from COVID-19. To date, more than 8,000 patients have been treated with convalescent plasma, and there are more than 2,000 participating sites across the U.S. 13 When SARS-Cov2 tests were in very short supply from the CDC, our Mayo Clinic Laboratories developed PCR testing within three weeks, and our partnership with Roche diagnostics increased capacity and relieved testing backlogs in several states. Mayo Clinic Laboratories also developed a serology test as the next critical tool for health care providers. Simultaneously, we are working with the state of Minnesota, the University of Minnesota, and other Minnesota health care providers to accelerate state-wide testing using both types of tests, while also working with other U.S. states including Florida and Arizona. All of these efforts provide a view of an even more robust and nimble approach to medical science and application that needs to carry forward beyond this era.

Meanwhile, we are observing first-hand the power of engaging industries with diverse, even seemingly unrelated, capabilities. Medical device makers and car manufacturers have joined forces to mass produce ventilators and streamline ventilator design. 14 The partnerships may demonstrate new avenues for device development that will set us in better stead to address future pandemics.

The COVID-19 outbreak also has vaulted collaborative opportunities to apply artificial intelligence (AI) and machine learning to new medical problems. Researchers in China have used AI to reveal distinctions between the CT scans of patients with COVID-19 and those with other pneumonias. 15 Other research teams are using AI to identify new treatment pathways. 16 Tech companies are working with hospitals in New York City to use AI platforms to assess the risk profiles of non-hospitalized patients. To help with diagnosis and risk stratification even before infection occurs, Mayo Clinic researchers are using AI to study whether data from ECG can help predict who is infected with and susceptible to COVID-19.

Overall, the new challenges posed by the pandemic are sharpening our skills and quickly teaching us the ways AI can enhance care. Before the outbreak, Mayo Clinic had established a partnership with Boston-based company nference to use AI to match potential treatments to diseases. Through the pandemic, our partnership has greatly expanded its AI applications to a variety of COVID-related questions, from keeping track of testing in real-time to predicting hot spots.

In fact, efforts to track and trace the virus, particularly using big data and AI, reveal health care organizations, industry partners, and government agencies will be engaged together in matters of epidemiology well into the future. Some governments, as in China and South Korea, are deploying tracking initiatives, using combinations of smartphones and other tools that gather information regarding location and activities, such as credit cards. 17 These and future efforts will have to balance the imperative for large-scale, rapidly acquired epidemiological datacollection with individual privacy. large networks and resources to solve complex problems simultaneously instead of solving them one at a time in isolation. This will accelerate the digital platform model in health care and help more people. Now is the time to build upon new digital care options to address urgent needs for the crisis we face today, but also to form the foundation for how we deliver care tomorrow. Through our united efforts, the pandemic will eventually come under control, and, in the process, we will have achieved a more nimble, consumer-friendly digital health care system that can better stand up to future challenges. Considering everyone and everything we have lost to COVID-19, we should fight determinedly for this thin but essential silver lining.

World Health Organization

WHO Coronavirus Disease (COVID-19) Dashboard

Variation in government responses to COIVID-19

World Health Organization. Responding to community spread of COVID-19

Federal Communications Commission. FCC approves first set of COVID-19 telehealth program applications

Delivering more care remotely will be critical as COID-19 races through communities

Enabling rapid and open access to epidemic and pandemic virus data

WHO launches global megatrial of the four most promising coronavirus treatments

Accelerating research on COVID-19 in resource-limited settings

Mayo Clinic named national site for convalescent plasma expanded access program

Ford and GM are undertaking a warlike effort to produce ventilators. It may fall short and come too late

A deep learning algorithm using CT images to screen for Corona Virus Disease (COVID-19)

Health care of tomorrow, today: How artificial intelligence is fighting the current, and future, COVID-19 pandemic

After 9/11, we gave up privacy for security. Will we make the same trade-off after Covid-19? Health Tech

Screening for cardiac contractile dysfunction using an artificial intelligence-enabled electrocardiogram

The authors thank Kate Ledger for her contributions to this editorial.
