Combating the Pandemic via AI and Diagnostics: Highlights from the “TAIWAN is Helping: AI x Pandemic Prevention Online Forum”
The second installment of the “TAIWAN is Helping: AI x Pandemic Prevention Online Forum,” conducted at the China Medical University on June 20th, featured rousing discussions on topics related to pandemic control. Sponsored by Taiwan’s Ministry of Science and Technology (MOST), the event was co-hosted by MOST All Vista Healthcare Center, China Medical University and Affiliated Hospitals, and Center for Artificial Intelligence and Advanced Robotics at the National Taiwan University (NTU). The forum invited esteemed speakers from the government, academia, and the biopharma industry to cover four major aspects of anti-pandemic efforts:
1. Public health response strategies
2. Medical care
3. Digital healthcare technology
4. Diagnostic development and application
Innovation and Mutual Care: The Two Magic Bullets
In his introductory speech, Dr. Chien-Jen Chen, former Vice President of Taiwan and renowned academician of Academia Sinica, said, “Infectious diseases have a great impact on human civilization, and the war against them has been fought numerous times in human history. We have won several battles against infectious diseases by learning through prior experiences”. For instance, the use of patient isolation to combat infectious diseases was gained from the plague that spread in the village of Eyam in Europe in 1665. This is the first time humans implemented the concept of large-scale isolation to prevent an epidemic from spreading to other villages. Dr. Chen is optimistic that with the advancement of civilization and technology, the world is becoming more familiar with bacteria and viruses. Therefore, the concept of pandemic prevention is improving over time.
Yet, medical resources are limited to care for many severely ill patients with infectious diseases. Therefore, two main strategies have been adopted for pandemic prevention; contact minimization and vaccination. Currently, an efficacious COVID-19 vaccine is still elusive. Hence, the Taiwan government is trying to control the pandemic by collaborating with industry, academia, and the medical community. The collaboration has led to the development of several technologies, such as smartphone applications for social distancing and health reports, automatic chest X-ray detection systems, virus strain analysis, and AI drug development. In addition to patient isolation, social and border control policies, and active public cooperation, the implementation of technologies has kept the pandemic under control. Dr. Chen concluded by saying technological innovation and mutual care are the magic bullets to combat infectious diseases.
High-Throughput Drug Screening to Identify Anti-COVID-19 Drugs
Dr. Mien-Chie Hung, President of China Medical University, who specializes in studying targeted cancer therapies, shifted his research focus to antiviral drug development since the pandemic. His team’s analysis of the protein structure and the gene sequence revealed that the SARS-CoV-2 genome was rather small, and is only 0.001% of the human genome.
Dr. Hung’s research group performed a high throughput screening of potential drugs that might bind to SARS-CoV-2. After screening about 4400 compounds, including more than 2000 US FDA approved drugs, 1250 known antiviral compounds, around 1100 natural compounds, and Taiwanese herbal medicinal extracts, his group found that GC376, the antiviral drug for feline infectious peritonitis, has a good antiviral effect against the virus. GC376 was found to covalently bind to the active site (Cys145) of SARS-CoV-2. Besides, a promising antiviral natural compound and an herbal medicine compound were also found. Since Taiwan does not have enough COVID-19 patients, international cooperation would be necessary to evaluate them in humans.
Case Detection and Infection Blockade, the Golden Rules for Prevention
Dr. Kao-Pin Hwang, Vice Chairman of Hospital Infection Control Committee at China Medical University Hospital and Commander of Taiwan Centers for Disease Control in Central Taiwan, said, “The golden rules for the prevention of COVID-19 are through case detection and the blockade of infections.” Hospitals have adopted a rolling anti-pandemic control policy to prevent the spread of the virus. This included: entry and exit quarantine policy, isolation care of clinical staff, restricting to one access channel, setting up negative pressure isolation wards early, and pandemic prevention clinics.
Moreover, unlike the SARS epidemic of 2003, the medical cloud query system is now activated. The system is equipped with an electronic referral platform, entry quarantine, alert newsletter, electronic fencing system that allows the government and civil affairs agencies to confirm suspected cases, and trace contact history instantly. To strengthen isolation measures, health insurance, big data, including travel history and professional history, are available on the system. Besides, pandemic prevention clinics have increased the feasibility of isolation and implemented tracking and at-home management. To sum up, Taiwan’s success in pandemic control is a result of public understanding and the implementation of the right policies and technology.
Creating Value in Medical Service via Technology
Dr. Richard Hsu, Vice President of R&D, Department of Software of Compal Computer, said that “Due to the global COVID-19 pandemic, we observed that service providers, regulators, and consumers, all have high growth and high expectations in the telemedicine market. Everyone is interested in witnessing the use of technology in improving medical service.” For example, Facebook strengthens the connection between medical materials and users, volunteers, donations, and medical units through online communities during the pandemic. On the other hand, Apple applies personal devices to track messages to confirm the spread.
From a technological perspective, the integration of medical resources and the distribution of information are quite effective. Compal cooperated with the medical community and the Taiwan government to create an output value of approximately 3 billion in the first half of 2020. Specifically, its cloud system can help improve telemedicine in several ways:
1) Home caregivers and physicians can get closer to patients more quickly and confirm the case status in real-time.
2) Business products and online courses can be provided at once at a low cost.
3) With cloud service, payment, video-recording, and archiving can be synchronized easily.
4) The collected data enables the creation of online consultation or medical information windows and perform database analysis and research.
Hence, telemedicine products can be continuously improved to serve the needs of users.
HoMe App Plays Key Role in Smart Home Management
Dr. Tzi-Cker Chiueh, Vice President and General Director of Information and Communications Research Laboratories, Industrial Technology Research Institute (ITRI), pointed out an important issue. He observes that many personnel such as the village chief, village officer, and police units have to be managed judiciously to ensure adequate home quarantine during the pandemic. He believes that smart home management can reduce the consumption of these human resources, and can resolve problems like unclear mobile phone positioning of quarantined persons.
He listed all the new automated technologies that are utilized to improve home quarantine. For example, GPS and Wi-Fi could track personal footprints with a mobile phone. Similarly, cameras and biometric systems in mobile phones can be used for identity verification. Mobile Apps can send reports of home quarantine individuals to community officials or police units at certain intervals. The global positioning system can record the network environment around the phone and remind users to open programs to interact or confirm messages. The HoMe App, developed by Chiueh’s group at ITRI in just three weeks, utilized anonymous Wi-Fi to minimize privacy concerns and allow compatibility of the HoMe App between different types of cell phones.
Anti-Pandemic Technology for Better Medical Outcomes
Taiwan’s success in containing COVID-19 within three months of the first patient report in Wuhan last December is an outcome of the lessons learned from the SARS outbreak 17 years ago. Dr. Dar-Bin Shieh, Deputy Minister of the Ministry of Science and Technology, said that since the SARS epidemic, Taiwan had begun to implement comprehensive anti-epidemic technology. Furthermore, this year, Taiwan has also kept up with the U.S. in its use of Emergency Use Authorization (EUA) for rapid customs clearance, and some regulations have been loosened to allow more pharmaceutical products and research results. The government also launched a pandemic command center to check research plans and resources. In addition to that, an open scientific platform was also established by Academia Sinica. All these actions allowed the government, medical community, and the industry to work together to resist the onslaught of COVID-19.
Several signs of progress have been made during this fight, including:
1) New drugs that target the virus’s nucleocapsid protein were developed by Ming-Hon Hou, a professor at National Chung Hsing University.
2) The National Health Institute’s research on tylophorine compounds against some coronavirus.
3) The development of a Bio-nanoparticle vaccine against COVID-19 by Dr. Che-Ming Hu of Academia Sinica.
4) Research on the sequence of the virus strains by the Research Center for Emerging Viral Infection of Chang Gung University.
5) Yallvend’s software and smartphone applications for mask purchases.
6) Utilization of AI in COVID-19 detection.
In summary, Taiwan’s successful containment of COVID-19 can be attributed to the integration of its strength in AI, ICT, IoT, and the seven cores of COVID-19 prevention: testing, treatment, prevention, public health epidemic, social impact, field verification, and international cooperation.
AI, an Accelerator for COVID-19 Treatment and Future Medical Care
Dr. Min Sun, Appier Incorporated’s Chief AI Scientist, shared how AI can be an auxiliary medical tool. He noted that AI could assist in all aspects of medicine, including disease prediction, detection, diagnosis, treatment, and follow-up tracking. The use of AI in electronic health records can help reduce readmission rates, assist in drug screening, and drug repurposing. It can also help in establishing pandemic prevention maps, which can track possible contacts by suspected COVID-19 patients through contact tracing. It can provide recommendations on medical resource allocation for different areas, and accelerate diagnosis in the immigration system.
Moreover, with sufficient models and data, AI can accelerate several biomedical processes, such as reviewing chest X-rays, examining virus strain distribution and evolution, and examining protein structure calculations to predict drug efficacy. To sum up, this tool could assist both government decision-making, and personal health management and be an accelerator for COVID-19 treatment in the future.
Digital Diagnostic Testing could Solve Problems in the Future
Mr. Tsung-Ching Lin, President of General Biologicals Corporation (GBC), said that the pandemic had accentuated the value of preventive medicine, which has mostly been just a buzzword until now. He said that the spread of the virus could be prevented by diagnostic testing, which enables quick isolation and quarantine of patients and their contacts. Common detection methods such as PCR (quantitative and real-time), ELISA, and rapid tests for viral antigens and antibodies help in the scanning, prediction, monitoring, diagnosis, treatment selection, and prognosis of diseases.
He also shared the characteristics and specific detection methods for different pathogenic viruses such as Hepatitis B, C, and D, AIDS, SARS-CoV, and SARS-CoV-2. He concluded that digital diagnostic testing may play an important role in the future and may help answer some burning issues raised by COVID-19:
Will coexisting with COVID-19 become the norm?
What is the proportion of people who develop antibodies after COVID-19 infection?
How long can the antibodies last?
How could COVID-19 vaccines and drugs be screened and monitored?
Prognosis monitoring of COVID-19 patients
Medical AI application
Tools for clinical research
Automated Detection Methods to Bolster Border Protection
Aaron Chen, Chief Operating Officer of TCI Co., Ltd, said that there are currently 34 new SARS-CoV-2 testing institutions in Taiwan that can test up to about 3400 samples a day. He acknowledged the several problems that arise during the early stages of an outbreak. In the beginning, testing methods could be slow and inaccurate. Currently, the main SARS-CoV-2 detection method is RT-PCR, which is used universally throughout the world and is more accurate for global quarantine units. However, the prolonged screening time, requirement of human operation, and high cost have proven to be major impediments.
Hence, TCI Co., Ltd aimed to manufacture a nucleic acid detection instrument that employs an automated reagent dispensing system to simulate human experimental actions for nucleic acid extraction and reduce the possibility of cross-infection and improve accuracy. The equipment can test up to about 2016 samples per day, which is equivalent to 10 testing laboratories (with 40 medical examiners working 24 hours non-stop).
Currently, Taiwan may not need such an instrument, as it has successfully contained the spread, with no new cases of COVID-19 in the community in the past two months. However, the automated COVID-19 detection instrument may still be useful in pandemic prevention measures at the airports. The automated COVID-19 detection instrument can dramatically cut down the diagnosis time from 3 days to 4 hours and work well with a mobile App.
Post-Pandemic Outlook of AI Application in Biotechnology, and Medical Care
A panel discussion that followed saw Dr. Johnsee Lee, Chairman of the Taiwan Bio Industry Organization host distinguished panelists that included,
1) Dr. Shou-Mei Wu, Director, Food and Drug Administration of Taiwan
2) Dr. Shiing-jer Twu. President, Development Center for Biotechnology
3) Dr. Ti-Hao Wang. R&D Director, EverFortune.AI
4) Tsung-Ching Lin, President, General Biologicals Corporation
5) Aaron Chen, COO, TCI Co., Ltd
Dr. Shou-Mei Wu said that AI has assisted in the upgrade of several industries during the pandemic, including medical research, and the supply chain of masks and protective clothing. As for the diagnostic industry, president Tsung-Ching Lin shared Taiwan’s research capacity in manufacturing SARS-CoV-2 virus detection kits. Apart from the reagent kits, Aaron Chen also mentioned the production of fully automated instruments in SARS-CoV-2 virus detection.
When Dr. Johnsee Lee raised his concerns on the speed of regulatory approval and export of virus detection kits abroad, Dr. Shiing-jer Twu admitted that the Food and Drug Administration of Taiwan is in a tough position to ensure sufficient detection kits for Taiwan and the challenges in guaranteeing the safety and quality of exported kits.
Dr. Ti-Hao Wang concluded that applying AI in medicine will ultimately depend on data quality and clinical needs. Understanding the true clinical needs will then unleash the potential of AI in medical care.
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