In a climate of widespread uncertainty about COVID-19 and rapidly changing guidelines for diagnosing and treating the disease, many healthcare professionals struggle to explain the test results and treatment plans to patients. The challenge is especially acute in multicultural societies like Singapore with large communities of foreign migrant workers.

To help overcome these challenges, a team of clinicians and technologists led by Dr Scott Wong, a medical officer at the Ng Teng Fong General Hospital (NTFGH) and Jurong Community Hospital (JCH) in Singapore, recently developed a digital app that supports migrant workers with suspected or confirmed cases of COVID-19 infection. The Lab Insights team recently caught up with Dr Wong to better understand his solution, which is open source technology and freely available to any institution or government.

An idea from the frontlines

In the initial days of the pandemic, Singapore confronted COVID-19 effectively. But infections soon rose rapidly among the migrant worker population, who are housed in close quarters in large dormitory facilities. These dormitories can hold as many as 30,000 workers, with several people to a room and shared baths.

For healthcare workers on the frontlines of the containment efforts, long hours in full personal protective equipment (PPE) and in the sweltering tropical conditions was the norm. As one of those frontline healthcare workers, Dr Wong experienced the challenges firsthand. Initially armed with only a pen and paper, he longed for a better way to record patient information and communicate diagnostic and treatment decisions.

But that wasn’t the only challenge. The migrant workers, who hail from many different countries and speak a host of languages, often encountered difficulties when answering questions or understanding information from healthcare professionals. As illiteracy is also common in this group, the written guides or test results were of limited utility.

“It was fast-paced as hundreds of patients had to be rapidly triaged and isolated daily,” says Dr Wong. “We did not have the luxury of time to address all their queries – from what a positive result meant to where and the duration of their quarantine. Often, they simply did not know what to tell their employers or their families.”

That was when Dr Wong realised that incremental changes would never be sufficient and the idea for the “COVID Buddy” app was born.

User-centric development, rapid deployment

Dr Wong learnt one key thing while treating migrant workers: “In a survey of 100 COVID-19 positive patients, 98 per cent had an android phone,” he said. If an app could gather accurate information about symptoms and report results in multiple languages, with multimedia tools to help illiterate workers and the ability to function offline, it would overcome many of the most pressing problems.

In about a month, Dr Wong and his team developed the COVID Buddy app, which can communicate in English, Tamil, Bengali, Thai and other languages. The project was partially funded by Singapore Biodesign [1], a national healthtech innovation programme affiliated with Singapore’s Agency for Science, Technology and Research.

Users can launch the app at any hospital or a community care facility with free wi-fi access; after that, the app no longer requires internet access to function. Individuals or groups of patients can select a language and respond to audio and image cues about their symptoms, such as fever or shortness of breath. This eliminates the need for extended interviews with medical professionals and reduces everyone’s risk of infection.

Each user is assigned a QR code that allows healthcare workers to obtain results from a safe distance. When results come back from the clinical lab, the clinicians can quickly key in topline results about chest X-rays or serology tests using a multiple-choice interface. The patient can view those results in pictures plus their choice of language, and will receive counseling about recommended treatments or isolation protocols.

“It’s a progressive web app designed to be very robust and useful even without internet access and which works even on old android phones that cost $150 to $250 dollars,” said Dr Wong, who lent his own voice for the English and Chinese language versions of the app.

“We had to be very flexible to adapt to a fast-moving pandemic where nothing is certain. The team can change the app within two hours to respond to important updates in treatment recommendations, quarantine protocols and more,” he added.

Real-time cluster detection

Dr Wong and the COVID Buddy team have been testing the app for the past two months, streamlining the user interface as they watch people engage with it every day. Most patients who use it began at hospitals and community care facilities – such as NTFGH and JCH where Dr Wong works at and within the National University Health System.

At the policy level, the app can make a difference with real-time detection of clusters that allows intervention efforts to spot outbreaks and allocate resources accordingly. Dr Wong noted, “Based on trends in positive and negative results through the app, you can rapidly predict how much coronavirus is in an area.”

Dr Wong recognised early on that COVID Buddy could be useful beyond Singapore’s borders and publicly released the app’s code for other healthcare institutions and governments to implement and adjust it, such as updating treatment recommendations based on what’s approved in that country.

“It allows other people to customise the solution to their needs, which is absolutely essential to combat this global pandemic,” he said.

[1] Singapore Biodesign, Agency for Science, Technology and Research (A*STAR) Singapore