EDITORIAL TEAM: Caroline Soyars, Global Health Design Initiative, University of Michigan; Grace Burleson, Engineering for Change; Mariela Machado, Engineering for Change

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Engineering response to the novel coronavirus (COVID-19) pandemic is pivotal in devising new technologies and solutions to mitigate negative health outcomes worldwide. In low-resource settings, the availability and suitability of technology and engineered solutions are especially pressing. In this report, we categorize and identify best practices, standards, guidelines, and insights related to technology use during the COVID-19 response in low-resource settings. The document is intended to serve as a reference for technologists in current and future pandemic responses. In the full report, over 170 resources are categorized into 21 tables, which are organized under six overarching areas: (1) Standards for all medical devices, (2) Transmission mitigation, (3) Diagnostic technologies, (4) Management and treatment technologies, (5) Maintenance and optimization of existing technologies, and (6) Environmental health and safety. In the full report, each resource is categorized by name, publisher, type, audience, and purpose.

Standards for all medical devices

A number of standards and regulations are laid down to include requirements, application of management, labelling, and packaging of medical devices. Many international organizations like ISO, WHO, CDC, and FDA are playing a crucial role in providing regulations on emergency use and authorizations of medical devices for COVID-19 situations.

Transmission mitigation

Transmission mitigation measures include maintaining hand hygiene, social distancing norms, and use of Personal Protective Equipment (PPE), such as masks, gowns, goggles, aprons, and gloves. Local preparedness for maintaining hand hygiene involves water, sanitation, waste management, and consumables such as soap and dispensers. Institutions, such as the U.S CDC and UNHCR provide guidelines for washing hands and maintaining hygiene in healthcare settings. The WHO and UNICEF provide recommendations for local manufacturing of soap to be used in low-resource settings. There is also an increase in the number of deployed sanitizer dispensers at the entry and the exit of the buildings in use. Contraptions such as pedal powered wash basins and automatic sanitizer dispensers are developed and distributed in institutional settings, government offices, and public places that are functional after the lockdown relaxation.

Read more about innovation in medical devices and PPE during the COVID-19 pandemic.

Furthermore, transmission mitigation measures include social distance and contact tracing. The U.S CDC provides guidelines on maintaining social distance in a variety of public settings. Evidence of successful contract tracing programs can be found in some countries, such as South Korea, where mobile information, GPS, and credit-card transactions were used for contract tracing and supported the control of the virus across the country. Notably, there are no technological standards related to contact tracing or social distancing recommendations, with the exception of “2 arms’ length distance” recommended by the WHO. Occupational health and safety guidelines from various countries currently do not mention the use of PPE for the prevention of disease spreading, however the WHO and CDC has laid guidelines on best practices for the at-home manufacturing, wearing, and washing of masks during the pandemic. There are few standards and regulations specific to face shields, and almost no public guidelines on their use. Public health organizations continue to recommend that healthcare workers use respirators with at least a N95 or FFP2 filter grade in clinical settings with COVID-19 patients. PPEs such as goggles, aprons, and gowns are less common compared to face shields and masks in the global COVID-19 response and no guidelines regarding their use have been published nor have design and manufacturing initiatives been formed. Unlike other PPE kits and equipment, there are no community makerspace groups dedicated to glove manufacturing likely due to the complexity of glove manufacturing especially the rubber processing that is required.

Diagnostic technologies

Diagnostic technologies for COVID-19 are limited to viral tests and antibody tests. Most diagnostic tests use polymerase chain reaction machines (PCR). However, many studies have been conducted to enable testing even in a low-resource environment including information and communication technology (ICT) diagnostics and artificial intelligence (AI) diagnostics. Research is underway to use AI to configure lung ultrasound detecting specific patterns and diagnose the patients through image analysis. A number of self-diagnostic solutions through the mobile phone applications such as Aarogya Setu (India) and telehealth programs, are in use in resource constrained settings.

Read more about innovation in testing and ICT diagnostic solutions.

Management and treatment technologies

Management and treatment technologies such as oxygen therapy devices and ventilators, which are included in the WHO’s List of Priority Medical Devices for COVID-19, primarily required for severely ill and critical patients. International Standards and guidelines for technical specifications and enforcement policies for the adoption and fabrication of different types of oxygen therapy devices have been issued for the COVID-19 response by entities such as the WHO, AAMI, MHRA, APSF, and FDA. International standards are available related to oxygen concentrators, non-invasive ventilators, invasive ventilators and their related oxygen delivery devices such as masks and nasal cannula. The WHO has also issued an interim guidance of the technical specifications for invasive and non-invasive ventilators for COVID-19.

Maintenance and optimization of existing technologies

A number of multilateral and national regulatory bodies have published guidelines for managing long-term use of existing medical devices, and how to reuse disposable products including masks thus maintaining and optimizing the existing system. Guidelines provided by WHO ensure that health care workers create their own checklists to maintain their technologies. Many organizations including WHO, PAHO, and the ministries like MoHFW give guidelines and training materials to doctors, volunteers, researchers, and others associated with COVID-19 .

Environmental health and safety

Waste Management is one of the pivotal factors to decelerate the rapid spread of COVID-19. WHO, United States Department of Labor, CDC, and the European Commission provide guidelines and training materials to manage highly contagious waste according to the level of the waste risk. Cleaning and disinfection guidelines issued by UNICEF and USFDA instructs the workers to wear skin protection and eye protection against potential splash hazards and adequate ventilation is required.

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