The digital network of networks: Regulatory risk and policy challenges of vaccine passports

The extensive disruption to and digital transformation of travel administration across borders largely due to COVID-19 mean that digital vaccine passports are being developed to resume international travel and kick-start the global economy. Currently, a wide range of actors are using a variety of different approaches and technologies to develop such a system. This paper considers the techno-ethical issues raised by the digital nature of vaccine passports and the application of leading-edge technologies such as blockchain in developing and deploying them. We briefly analyse four of the most advanced systems - IBM's Digital Health Passport “Common Pass,” the International Air Transport Association's Travel Pass, the Linux Foundation Public Health's COVID-19 Credentials Initiative and the Vaccination Credential Initiative (Microsoft and Oracle) - and then consider the approach being taken for the EU Digital COVID Certificate. Each of these raises a range of issues, particularly relating to the General Data Protection Regulation (GDPR) and the need for standards and due diligence in the application of innovative technologies (eg blockchain) that will directly challenge policymakers when attempting to regulate within the network of networks. © The Author(s), 2021. Published by Cambridge University Press

Prone positioning to improve oxygenation in COVID-19 patients outside critical care (prone-COVID study)

Introduction: Prone positioning has potential efficacy in improving oxygenation in patients with coronavirus disease (COVID-19). The UK Intensive Care Society has published recommendations for prone positioning in awake patients with COVID-19 but it remains unknown whether it is beneficial in those patients prior to requiring respiratory support, and whether there is applicability for patients with non-COVID-19 pneumonia. Published studies are limited by their retrospective nature, inclusion of minimal time-points for physiological assessment and lack of information on tolerability. This prospective study aimed to assess the tolerability and physiological effects of prone positioning in non-ventilated patients with or without COVID-19 pneumonia. Methods: This interventional case-control study (ClinicalTrials.gov Identifier: NCT04589936) is currently being conducted at a tertiary hospital, with the aim of recruiting 56 patients with pneumonia. Inclusion criteria include those able to provide informed consent and rotate independently through a cycle of supine, lateral (for a duration of 15 minutes) and prone position (for as long as tolerable). The tolerability of each position was qualitatively assessed using a questionnaire and visual analogue scores (VAS). Continuous assessment of oxygenation, respiratory rate, end tidal carbon dioxide and pulse rate will be performed throughout the cycle of position changes. Thirtytwo of these patients will be proned for a longer duration, using a non-invasive positional sensor which will correlate body positions with the tolerability and physiological effects. Statistical analysis of ordinal VAS data was performed using a non-parametric Freidman test and demographic data presented as median (range). Results: The progress of participant recruitment is summarized in figure 1. To date, 73 patients with pneumonia were identified, 22 of whom were approached, of which eleven patients (eight COVID-19 and three non-COVID-19 pneumonia) underwent proning (6 female, 5 male;age, 67 [25-88] years;body mass index, 27.3 [22.8-32.0] kg/m2). There were no significant differences between different positions in the VAS for breathlessness (p=0.41), although the VAS for discomfort worsened between the supine (median score 2) and prone (score 5) position with a trend towards significance (p=0.100). Conclusion: Whilst awake prone positioning is recommended in national guidance, our prospective study to date highlights the challenge in recruiting patients who are suitable and are successfully able to self-prone. Our qualitative data suggests some patients experience discomfort in the prone position. Further detailed characterisation of physiological variables with ongoing recruitment will help inform the feasibility of performing prone positioning in hospitalised patients with pneumonia.

Knowledge and skills sets for telecare service staff in the context of digital health

Telecare services have an established place within the United Kingdom. Through using online technologies to help mostly older people to remain at home, they are recognised as having a support role for health as well as social care. This positions telecare services within the broader realm of 'digital health'. As that position becomes more embedded, it poses questions about the nature of tasks that are (or should be) undertaken by telecare staff, and regarding the knowledge and skills that are required. A convergence of telecare and telehealth services is indicated together with a need for some kind of accord or accommodation. This paper summarises the United Kingdom policy context;references the technologies that are provided by telecare services or can be linked to them;notes briefly the impact of the COVID-19 pandemic;and proposes six knowledge and skills sets. Outcomes of the UTOPIA study undertaken in England from 2016 to 2017 are drawn upon: this study provided important information from over 100 local authority telecare managers.