Satellite navigation

The widespread use of devices embedding satellite navigation proposes an alternative to the traditional face-to-face medical follow-up of patients, which is particularly relevant to tackle global public health emergencies.

In China, satellite technologies and space-based systems, especially the BeiDou Navigation Satellite System, have been crucial in coordinating and protecting all sectors of society against the highly contagious virus. From tracking patients’ position to the monitoring of cargo transport, as well as using GNSS-guided drones for large-scale disinfection missions, satellite positioning has proven to be a major asset. In order to ensure all patients are effectively identified and treated, as well as to reduce the risk of cross-infection between patients and medical staff, a BeiDou GNSS-based social app (Wuhan Mini Neighbourhood) was launched on WeChat (the messaging app with the greatest number of users in China). By exploiting BeiDou’s navigation and positioning capabilities, China was also able to dispatch more than 10 000 disinfection drones to perform nationwide aerial disinfectant spraying with centimetre-accuracy. Most of the drones originally served as agricultural sprayers, but traded pesticides for disinfectant fluid to prevent the further spread of the virus. Furthermore, the HaiGe Smart Epidemic Prevention Management Platform, a BeiDou-based system for health monitoring, provides a solution to mitigate the fears of employees about facing the Coronavirus during their commute to work. With the outdoor and indoor location history of patients, and by connecting the database of the infected persons with regional information, the platform is capable of displaying a real-time cartography of infectious disease locations.

The system can automatically adapt the travel route for users to avoid contagious areas. Due to transport restrictions, adapting routes is also something to consider for the delivery of medical supplies and daily necessities. A GNSS-based vehicle network guides the way for both regulators and drivers. Considering that satellite connection works in remote locations and allows for real-time communication with isolated drivers, China’s transport management department equipped all vehicles to Wuhan with BeiDou mobile satellite positioning devices. Finally, indoor autonomous robots rely on satellite navigation for the contactless delivery missions to distribute medical supplies and groceries in the designated hospitals and local communities under quarantine.

In South Korea, a smart city technology system recreates the movements of confirmed COVID-19 cases, using data such as surveillance camera footage and credit card transactions. This new system allows data about confirmed COVID-19 patients to be immediately analysed by health investigators. Central and local administrations in South Korea are sending real-time alerts via text messages and apps about the number of confirmed cases, as well as the travel histories of those infected. The “self-quarantine safety protection” app, developed by the Ministry of the Interior and Safety, uses satellite navigation to make sure people are not breaking their quarantine.

The approach of tapping into mobile location data to reconstruct the movements of coronavirus positive people and those who encountered them, has sparked concerns about privacy. In Europe, research teams are now considering less invasive ways to collect and share data about infections. To connect innovative ideas and to halt the pandemic, the European GNSS Agency (GSA) is calling for apps supporting authorities and citizens in the COVID-19 emergency response and recovery. It has also listed location GNSS Galileo based Applications that may be useful in response to the diffusion of COVID-19. In this so-called age of “surveillance capitalism”, public concerns about the exploitation and abuse of data are high. However, both authorities and the public will have to weigh the value of privacy against the importance of collecting data that can help in saving lives.

Overcoming the crisis, and more?

Satellite data strikingly capture the immediate effect of change in human behaviour on the environment. GIS-driven spatial health information, remote sensing, telemedicine, satellite communication, and global navigation satellite systems, are playing a major role to counter the COVID-19 crisis, supporting a wide range of activities such as monitoring, diagnosis, screening, quarantine, treatment, disinfection operations, and transport. The European Space Agency is inviting more ideas to further pursue space-based activities delivering innovation and digitalisation for citizens and communities.

Space-based applications provide new alternative solutions to the classic in person doctor-patient meetings. Satellite communication and navigation support the eHealth trend. However, most national legal frameworks in Europe are ill adapted to the digitalisation of the health care sector. At a European level, there is a need for uniform norms to regulate telemedicine services, so to treat them as legal medical acts with equal access to reimbursement schemes.

 

Find out more about how the space sector responds to the pandemic:

• Call for space assets in response to COVID-19

• The strengthening of the health sector after the COVID-19 outbreak

• COVID-19 Tracing Apps and Data Protection Webinar Summary

 

For more initiatives around the world, check out the UNOOSA COVID-19 emergency response overview page facilitating the discovery of examples of contributions of space technologies.

WHO and its partners are seeking financing for protective equipment for frontline health workers; to equip diagnostic laboratories; improve surveillance and data collection; establish and maintain intensive care units; strengthen supply chains; accelerate research and development of vaccines and therapeutics; and take other critical steps to scale up the public health response to the pandemic. The COVID-19 Solidarity Response Fund, hosted by the UN Foundation (registered in the United States) and the Swiss Philanthropy Foundation (registered in Switzerland). Both foundations have established relationships with the World Health Organization, allowing for efficient transfer of financial resources to enable COVID-19 response efforts. Apart from giving online at www.COVID19ResponseFund.org, the UN Foundation can also receive donations via check or wire from around the world by contacting COVID19Fund@unfoundation.org. 

To answer to this need for trust-building, ECHAlliance has, as of 2011, been working on establishing a global network of ecosystems. Regionally-focused, such multi-stakeholder partnership-based structures aim to work together to implement innovative solutions that improve the quality of healthcare services for citizens and health professionals. In addition, the organisation has also set up a Digital Health Observatory of good practices “because the only way to overcome our personal limits is to share knowledge” Mr Cornet added.

Space based solutions can be part and parcel of the technology mix fuelling these new applications in healthcare. Whether they are addressing planning, e-learning, prevention, early warning or health-care delivery, numerous applications and technologies have been successfully tested in recent years.

Acknowledging the numerous benefits of such applications, the sector seems to suffer however from a serious case of ‘pilotitis’. ESA representative, Arnaud Runge, acknowledged that despite the large number of projects that have been supported by the Agency in Europe and elsewhere, few services have reached a status of operational continuity. “A pure technology demonstration approach proved insufficient without user driven demand and equitable risk sharing”, Mr Runge argued. Shifting perspective in the last decade, ESA has now been looking to contribute to the development of space-based health applications market by creating products and services in partnership with industry and users – so that these respond to existing needs and challenges. In addition, by adopting a co-funding model (rather than a subsidies based on) ESA aims to steer service providers towards achieving independent sustainability faster.

Different users, have also different needs. Needs that can vary not only across the sector itself, but also between national, regional and local policies and practices. Navigating such diverse needs in a labour intensive, complex system such as healthcare, is not an easy task. That’s why adaptability lied at the heart of the mobile telemedicine units developed by CNES and MEDES- DIABSAT and TIMM.

Having been deployed in the Occitaine region since 2010, DIABSAT has helped diagnose diabetes related complications for 3286 diabetic patients over 442 days. Conducted and operated by a nurse, the satellite connected van, has been a successful solution for the Regional Health Agency to address their “healthcare deserts” challenge and take services “beyond hospital walls”. 

Although France enjoys a reputation for having one of the world’s best healthcare systems, it has an aging population and a shortage of doctors, especially in rural areas. While DIABSAT is specifically equipped for medical examinations related to diabetes complications, ”it can be tailored to respond to a variety of medical specialities” MEDES’s Olivier Tournebize argued. Following DIABSAT’s model, the TIMM unit provides more advanced medical tele-imaging and teleconsultation services such as radiology, ultrasound, mammography or dermatoscopy consultations – satellite connected, anytime, anywhere. Similar projects have also been developed in the UK as part of prevention strategies for breast screening and colonoscopies, as well as for monitoring patients with diabetes complications.

France’s medical deserts are far from being an isolated case in Europe. Like in many developed countries, a system in which healthcare provision is arranged around hospitals, finds itself in need to adapt to social changes and patient expectations. Contrary to other EU members, France is however paving the way in terms of legislation which (as we argued in a previous report), can play a critical role to either hinder or enable the scale up of e-health solutions (once again, be they satellite powered or not). As of October 2018, after 10 years of feasibility studies, telemedicine consultations can now be legally covered by both public and private healthcare providers. A much awaited legislative change, according to experts present at the Pro Digital Health event. With France’s steadily increase in elderly population, demand for such services is expected to grow exponentially in the medium and long term (the share of the population over 65 years old has increased in France from 18.8% in 2016 to 19.6% in 2018) (1).   

Telemedicine has also proven a reliable solution for France’s overseas departments and territories. The French Guyana is defined by vast wilderness and its low population density. Here, satellite connected telemedicine services have been a vital tool to provide medical services and epidemiology monitoring to isolated communities. The telemedicine network which was set up in 2001, still serves some of the department’s centres today. In 2018 alone, over 60,000 consultations were conducted using a telemedicine service across 18 delocalized prevention and care centres.

To facilitate the use and integration of satellite communication based solutions, CNES with initial support from Midi-Pyrénées Region and Toulouse Métropole, has set up the CESARS Expertise Center. The assistance center, who’s operation is fully supported by CNES today, is tasked with providing advice to SMEs and public authorities facing connectivity challenges. As such, with the center’s support, interested parties can look into whether adding a satellite communication link would respond to their needs and improve their services, no matter the domain. According to Ms Sandrine Lafont from CNES, “any entity can benefit from the center’s council for ten days at no cost“.

When it comes to scalability, the cost of such services was one of the main concerns expressed by experts in the audience. Thus, perceptions pegging satellites to expensive services, remain widely spread amongst the general public. Despite the dropping costs for satellite communication services and the proven effectiveness of demand aggregation and resource pooling approaches, such perceptions are sometimes hard to shake. When in reality, satellites can actually provide a cost-efficient solution to cases where terrestrial communications are not set up or temporarily out of order (e.g. for occasional teleconsultations, as well as for urgent tele-expertise for cerebrovascular accidents).

Cost is not the only concern that needs tackling for users. So is the question of interoperability of telemedicine systems, and new technologies in general, with existing infrastructure, training needs and coordination between service providers. These and certainly many other aspects, together with tackling misconceptions surrounding space as being a completely remote actor from the medical sector, will still need the space sector’s attention. Yet, we are already a step forward as an important legislative bottleneck preventing businesses from setting up successful telemedicine solutions based on satellite connectivity was removed. Now, other EU members need to follow. 

For many participants, the potential of space applications and their affordability was a positive discovery, with many feeling encouraged to obtain more guidance on available solutions and services. Thus, showing there is (still) a constant need to bring space closer to users. To go where they are and bring their challenges forward. Going from space to society and back, hands-on products presentations were complimented by a trip inside the International Space Station’s medical facilities guided by ESA Astronaut Leopold Eyharts.

(1) https://www.insee.fr/fr/statistiques/3303333?sommaire=3353488