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· Title of the Project: A Systematic Literature Review of Technology Usage during COVID-19

Abstract (Executive Summary)

The COVID-19 pandemic has started in Saudi Arabia when the Kingdom reported its first case on 2nd March 2020. In response to the pandemic, the Saudi Arabia government and health authorities adopted many technologies that serve health, education and business sectors in terms of safe Continuity for essential activities. Nowadays, it is clear that digital transformation is not an option anymore, it is a necessity. The COVID-19 pandemic triggers the accelerated shift toward digital technologies and services especially in health care sector more than anything else to mitigate the risk of the pandemic and provision the essential services that everyone needed.

Due to this reason, countries were forced to act quickly and minimize the spread of the outbreak by taking few safety measures that were recommended by WHO. People were asked to observe social distancing, wash their hands regularly, refrain from touching their faces, restrict their movements and curfew implementation. The pandemic led to implementation of nationwide lockdown and movement restrictions. The implementation of the strict regulations all over the world was a mitigation strategy that was used to minimize the risks of spreading the virus further. However, as much as most countries were under lockdown globally, this did not stop the technological surge that was caused by the strict precautions kept in place as a mitigation strategy.

This paper will focus on some of the technological surge that impacted the healthcare sector, the education and commerce sector in Saudi Arabia. This paper will describe the various ways in which the healthcare sector, commerce and education sector made good use of the technology to ensure and enhance their efficiency and effectiveness in their operations thus providing improved and better services.

Objective:
The aim of this paper is to conduct a systematic literature review that highlight and Summarize the technological intervention that have been used to combat COVID-19 in Saudi Arabia.

Methods:
Manually searched on Google Scholar, Embase (Elsevier) and springer link, for relevant studies. Articles were selected based on the keywords, published data, peer-reviewed literature, and professional discussions, Ministry of Health publication, and the World Health Organization database.

Results:

A Proposed framework of technology adoption in KSA Health Sector that serve the public health in terms of video consultation, Surveillance system, contact notification, follow up, awareness.

2.0 Introduction

During the current COVID-19 pandemic, Saudi Arabia has been proactive in implementing disease containment measures and working to meet the community’s needs and demands in a very short time. It is currently estimated that 30,260,000 people in Saudi Arabia (89% of the population) use the internet, 96% of the population uses smartphones, and the majority of the population now has access to smartphones, laptop computers, desktop computers, and tablets; therefore, digital service provision is much easier than in the past and has aided the mitigation efforts established by the government [1]. Keeping in view the importance of quick and timely digital data sharing for policy actions, which is also emphasized by the World Health Organization (WHO), our aim in this paper, highlight and Summarize the technological intervention that have been used to combat COVID-19 in Saudi Arabia.

The fast spread of Covid-19 outbreak affected the entire world and led to implementation of strict regulations globally such as the implementation of curfew, movement restrictions, nationwide lockdowns, closing of schools, colleges and universities, banning of any sort of gatherings or any other activity that brings many people together in a common sitting. The risk mitigation strategies that were implemented, resulted to people taking to the internet and internet-based services in order to be able to communicate, interact with others and even in order to continue delivering on the job responsibilities while working from home [1]. The pandemic had an effect on the entire global economy, which affected both private and public sector. This effect impacted many businesses which led to closure or minimize on their staffing levels, which made so many people to lose their jobs during the pandemic. Those who were lucky to retain their jobs were asked to operate from their homes as a measure of mitigating the outbreak risks in the country. This factor highly contributed to the rise in use of information systems and networks with great changes in patterns and behavior like it has never been experienced before. Most of the business activities have shifted most of their activities to online, that is they have online meetings and conferences, they do online sales and marketing, effectively serve their customers using online platforms and conduct any other activities through online to enhance their operational efficiency.
The lockdown highly contributed to the digitalization of economic activities in the country, meaning that most business shifted their businesses to online or e-commerce. Online trading became the norm that people quickly adopted. Despite having the education institutions closed, the sector also quickly adopted to the online learning where student would use some applications from the internet such as Zoom and Google classroom to attend their daily lessons and even sit for automated exams.

Digitalization and technological surge hit the healthcare sector harder during the pandemic. Both private and public healthcare sectors were forced by the circumstances to work together and come up with technological ideas that will help them in curbing the outbreak [1, 2]. Many mobile apps and systems were developed for tracking people travelling and recoding the travelling history, some apps would record the patient’s symptoms and some made it possible to conduct contact tracing and even tracking the individual location, especially those who were on self-quarantine. The use of internet of things applications made things a bit easier and faster to the healthcare staff, especially to those who knew how to operate the IOT applications. Technological surge impacted this sector like no other, this is mainly because it was the most hit sector and was found completely not prepared to fight and curb the outbreak.

The healthcare facilities have been looking into newer technologies for purpose of monitoring and controlling the corona virus globally. And in order for the MOH to be able to monitor and control the spread of the virus, it is paramount that they have an accurate and trustable data in place. After the covid-19 outbreak, it was noted with a great concern that the existing technology could not effectively provide trusted data that could be used or provide the correct information about the novel outbreak. Some of the sources such as the public hospitals or the clinical laboratories have the potential of providing patients information affected by the covid-19 outbreak but the data may have been tampered with and cannot be fully be relied on since the data is not properly stored, monitored and probably not collected in accordance to the MOH set guidelines [1,2].

Technology has played a very vital role when it comes to tracking the spread of the virus with ease which has highly contributed to solving these kinds of issues. The use of technology has also helped in identifying high risk patients and has the competency of controlling the infection in real-time, also defined as a digital database that comprises of data that can be used simultaneously and shared within an extensive decentralized and publicly accessible network [2].

Some of the technologies used such as the artificial intelligence and blockchain technologies have been very beneficial to many business sectors since they consist of public data, distributed and decentralized. The blockchain technology for example, has three main parts that consist of blocks, miners and nodes. The chains contain several blocks, and each block has the potential of taking the information about the data, nonce and hash. The miners use a process called mining to create a new block of chains. Nodes are the electronic devices keeps its network functioning and preserve a copy of the blockchain.

2.0 Problem Statement

The aim of this paper is to investigate how COVID-19 have impacted business practices in Saudi Arabia and will focus on the education, commerce and healthcare sector. Digitalization of technology has shown a great potential in reference to achieving business continuity in the country, thus the need to understand the different kind of applications that can be used to enhance business functions in different sectors. A literature search will be conducted from December 2019 March 20 to September 2020. The information will be collected, examined, and analyzed on a designated sector.

1.2 Motivation

In healthcare, there are very vast opportunities for the use of technology. But unfortunately, this technology is not moving so fast. Saudi Arabia has been working to digitally transform many of its sectors since the pandemic started and many of the tools helped to combat the disease in the health sector the widespread usage of various technical platforms during the current pandemic, an experience of learning and sharing seems to be ongoing and worth to be documented [3].

This paper was motivated by the drastic changes in internet usage in the country and globally. The increased adoption of technology in certain sectors was fascinating since it shows how people can be very innovative and easily adopt to technology when are pushed to shovel.

When the pandemic hit the country, the government was forced to close all the learning institutions in the country as a mitigation strategy. Closure of learning institutions contributed to the dramatic shift to the online mode of transaction, where classes were held on video conferencing platforms such as Zoom and Google meet and classroom. Enrolments of synchronous platforms such as edx and Coursera have increased along with the synchronous modes of teaching in the country [3, 4]. Since the pandemic has prolonged longer than it was anticipated, most learning institutions have shifted entirely to the online mode of studying for the forthcoming academic year with exception of classes that require physical presence.

Businesses have also adopted the use of online technology and digitalization of some of their functions. Businesses have ramped up their technological infrastructure so that to account for the technological surge such as the use of video and audio-conferencing tools whose use have significantly increased during the pandemic. This has led most businesses to invest in advanced network equipment’s, expand the business bandwidth and invest in software that leverages cloud services [3, 4]. The Organizations that have the digital infrastructure in place that has the capability of handling bandwidth and the required work load, are able to let their employees to work from home, conduct online meeting and transactions and still remain relevant in the market.

Healthcare facilities have been the most impacted sector when it comes to technological surge. Healthcare facilities have been forced by the pandemic to adopt to digitalization and online services as compared to the traditional methods previously used where physical services were provided [4]. The pandemic led the healthcare sector to adopt various internet of things applications which enabled them to improve their efficiency and effectiveness in service delivery. The use of various internet of things applications enabled the sector to be more accurate when collecting information for analysis in statistics, faster in terms of efficiency and enable them to efficiently communicate in a timely manner.

1.3 Research Questions
Which different technological interventions have been carried out in the literature to combat COVID-19 in healthcare and education sector in Saudi Arabia? What are the effects and implications of COVID-19 in healthcare and education sector in Saudi Arabia?

1.4 Scope

The main focus of the study was to understand the different application of technology during the Covid-19 pandemic in Saudi Arabia especially in the healthcare sectors. The study will cover the main technological applications used that impacted the sectors some of which include the “Mawid” mobile application tool that was provided by the MOH that helped in facilitating online video consultation in healthcare sector. According to published data, consultations on Mawid system reached 176000 individuals per month. Another tool that was used by the MOH was the “Taqasi” platform which was specifically implemented in March 2020 to help in curbing the fight against the COVID-19 pandemic [5]. The main purpose of the Taqasi application is to enhance and manage contact tracing around the Kingdom based on the laboratory results generated from the HESN. HESN Network has been mainly used as a reliable source of data for all COVID-19 laboratory tests in the Kingdom. The HESN serves as a national communicable disease surveillance platform.

1.5 Paper structure

The rest of the paper is organized as follows: Chapter two, is the literature review of the study, this chapter will evaluate and look into the literature review articles that are relevant to this study, which will help and guide in identifying gaps in the various literature review studies. Chapter three which is the methodology of the study will immediately follow after completion of literature review. In this chapter, the study will focus on the methodology designs used, the data collection tools and the expected contribution of the study. Chapter four, will be the findings or the research outcome. This chapter will discuss how the data will be collected using the identified tool in chapter three, the data will then be analyzed and the outcomes /findings will be determined before deciding on the conclusion of the study. Chapter five will focus on the conclusion and recommendation of the study.

2.0 Literature Survey Outcome

By looking into different articles and different studies, a lot of effort have been done to shift toward digital solutions in a short time [6]. A lot of mobile applications that provide the same features were launched during the pandemic. Many initiatives were done in a short time without evaluating the user experience or user satisfaction. Also, the use of telehealth and Chabot’s were challenging and adopting the IoT technology is still not fast while it could help in the pandemic in many ways like distrusting foods to patients and measure the vital signs and protect the health worker from direct communication.

Technology was adopted in various disciplines and counties during the pandemic and some of the examples retrieved from the peer reviewed articles include the symptom tracker app technology that was initiated by United Kingdom to help them curb the spread of the outbreak. The application was designed in a manner that users would enter their symptoms for risk identification, follow ups and referrals [6]. The mobile application has been beneficial to the entire society since it helped in identifying individuals who were at a greater risk. Another decision support tool that was introduced by Google and Apple was the location checker that was implemented in the Tabaud application. This application enabled the ministry of health to track and keep tabs on the quarantined and self-isolated induvial movements.

Winarsih, Indriastuti and Fuad, highlighted how some countries used artificial intelligence (AL) in curbing the spread of the outbreak. Taiwan is one of the countries that that used artificial intelligence by integrating its improved national health insurance dataset with those of customs and immigration database in order to create big data for analytics and cross matching of people. These systems used web-based reporting and QR-Code scanning to determine the individual travel history and also traveler’s health symptoms to classify the traveler’s risk of infection, which was based on traveler’s origin of flight and current travel history for the past two weeks. Alerts were generated by these systems whenever the traveler would visit a clinic in order to aid case identification [6]. The travelers with lower risks were provided with a health declaration boarder pass which was sent to their mobile phones through text message for quicker immigration clearance, while those who were found to be at higher risks were self-quarantined at their homes and were tracked through their phones so as to ensure that they remain indoors during the incubation period.

The technology that was used to fight against Covid-19 in Saudi Arabia was similar and almost at the same level with those used by other countries globally, however, their adoption and implementation of the artificial intelligence requires more exploration. All the application created to assist in curbing the outbreak should be integrated so as to improve its efficiency and minimize the usage of too many technologies in fighting Covid-19. As a result, big data sets will be created and analyzed for specific functions by the government that may be beneficial to the entire country.

This paper has identified an existing research gap from the previous studies, this is because most of the previously conducted studies have used different technologies which are not recently updated when analyzing the positive and negative implications of technologies in different sectors such as the healthcare and education sector, thus the need to have a detailed review that would compare the type of technologies that were used in the past with those used to during the fight against Covid-19 virus [6,7] .A detailed systematic literature review which document all such studies in different sectors should be reviewed and updated.

2.1 Significant benefits of technology usage for COVID-19 pandemic

The use of technology has enabled distributed, encrypted and secured loggings of digital transactions be possible. The use of technology during the pandemic has led to revolutionization of computing in many areas, especially in areas where centralization is unnatural and privacy is critical [7] . The use of technology can be leveraged globally in tracking the spread of the covid-19 outbreak infection by developing networks applications that have been integrated on the mobile devices or the application can be downloaded using the smart phones. The technology that has been used and embraced by the MOH has the potential of protecting the patient information with high level of confidentiality. Some of these technologies has the potential of fast tracking the dug trials on patients, can keep the records and keep tabs on all the fund-raising activities and any donations by ensuring transparency at all levels. Some of the areas that have greatly benefited due to the use of technology in combating covid-19 in the health care sector include the outbreak tracking, donation tracking, privacy protection and medical supply chain management.

Another benefit of using technology in fighting covid-19 pandemic is the need of having a reliable and up to date data that is in regards to the covid-19 outbreak and the its wide spread globally[7,8]. The use of technology has made it possible to have a verifiable and secured data by integrating various technology and peer to peer networking features that enhances the use of technology and ensures effectiveness in its application. The use of technology has enabled the health care facilities to be able to keep tabs and records on patient’s information with covid-19 symptoms, geographical locations and also tracing the history of health conditions with a higher degree of privacy. Numerous platforms have recently been launched for purpose of facilitating in the sharing of the information and valuable data which is related to COVID-19. Some of the example that has been launched by the World Health Organization (WHO) is the MiPasa system which was launched in March 2020. It is a technology-based platform which fully facilitates the private data sharing between any individuals, state authorities or the health institutions [7,8]. Mipasa application also allows privacy-enabled sand self-reporting which allows MOH officials and individuals to upload data about different infection, at any given times and also identifies the exact location.

The use of technology enabled the MOH to be able to surveil the public during the Covid -19 pandemic. The use of technology made it possible for the health care facilities to successfully track the patient’s moment and provide real-time data about the affected areas and direct fighting efforts. Technology has proved to be a useful tool in tracking individual’s movement in a virus-free area. The government and health organizations have been able to monitor potential patients at every stage by using digitalized technology which are reliable and produce accuracy [8].

2.2 Benefits of digital infrastructure application for global health

Digital technology has been recognized globally as the new milestone in the implementation of mass intervention in context to Covid-19 outbreak. The digital technology has been used for contact tracing, diverse digital infrastructure which has taken the form of internet of healthcare things, big data and machine learning which have a played a very critical role in the efficient prevention and management of the new Covid-19 disease. Present applications of this technology have been expanding with time to include the development of meticulous treatment for patients infected with the COVID-19 virus, streamlining of medical capability, drug and vaccine discovery efforts and predictive analytics which helps in forecasting the trajectory of outbreaks.

Digital technology has shown the potential of minimizing the burden of participation by eliminating the need for continuous self-reporting. Also, the technology has an automated process that eliminates any recall biasness from the infected person that is in addition to other potential human errors and gaps in data reporting. Another benefit that has been enjoyed by many patients who are infected with the Covid-19 pandemic, is the reduction of the stigmatization effect that is mostly caused by having face-to-face interviews with the healthcare official contact tracing Investigation Team.

2.3 Main applications of technology usage in the COVID-19 pandemic
2.3.1 Traceability

Traceability in this paper means the tracking of infected patients since It is very important and there is a great need to control the spread of the coronavirus. With the use of modern updated technology, the MOH officers are able to track the infected patient’s movements, provide real-time information about affected locations and make reports on their fighting efforts [9]. Technology has also participated in the implementation of tracking individuals’ movements in virus-free zones. Some of the Information on safe areas such as population, location and current covid-19 outbreak status is recorded using various technologies. Medical supplies have been tracked continuously so as to ensure transparency in the medical supply chain.

2.3.2 Tracking of healthcare instruments

Technology has played a vital role in tracking healthcare instruments during the COVID-19 pandemic. It ensures that it keep tabs and records on how the healthcare tools and devices are stored and transported by ensuring the safety and security of movement of healthcare tools, systems and equipment’s from one place to another. Some of the tools used by the medical team or the health care service providers in fighting the covid-19 outbreak are things like masks, gloves, and protection gears [9].

2.3.3 Storage and transfer of treatment-related information

one of the most critical and challenging tasks during this COVID-19 pandemic is the storage of collected data and transferring the treatment-related information. Several studies have shown that between the years 2009 to 2017, more than 176 million patients’ records were exposed to data breaches globally. When the right technology is effectively used, it can help in keeping an incorruptible, decentralized, and transparent log of patient information [9,10]. The use of technology in the healthcare facilities has an advantage of allowing the patients, the medics and the healthcare service providers to share the same information quickly and safely without any fear of data being tampered with or exploited in any way.

2.4 Effective healthcare management during the crisis

In order for the healthcare service providers to ensure that they provide effective services to its patients, it needs to have a well-designed healthcare management system which will help them to deal with the crisis like COVID-19 in the present and for the future. According to a report published by WHO in the month of May 2020, it was established that in every month, the frontline health responders needs to be issued with more than 89 million masks, 39 million gowns, 76 million gloves, and 2.9 million liters of hand sanitizer in order to be able to protect themselves and others people they interact with on their day to day healthcare activities from COVID-19 [11]. By using and implementing several technologies, the healthcare facilities are able to manage the supply of all the above-mentioned items. The use of technology in the medical sector has also highly contributed in the improvement of the medical record management in Saudi Arabia, insurance claim process, clinical and biomedical research and advance biomedical and healthcare records during this COVID-19 pandemic.

2.4.1 Limitation of using technology

Various studies have observed that using technology in combating covid-19 virus has the following Limitations:

· Using of technology in fighting the pandemic has led the health care facilities and sector to use enormous energy consumption since all technological tools, applications, devices or equipment’s can only properly function by using power which means that it requires powerful hardware resources in every transaction done [12].

· Scalability is one of the major limitations of using technology. This is mainly because the system or applications validation may require some time due to the authorization of transactions by the majority of nodes.

· Maintaining the patient’s privacy is another challenge that has been faced by many healthcare facilities, this is mainly caused by lack of proper storage technological devices that has the capability of protecting the patient’s information confidential and private and importantly way from unauthorized access.

· Most of the technology used in the healthcare, education and commerce sector tend to be complex and complicated and may need some sort of expertise to operate them or may require the users to undergo some sort of training in order to be able to understand the technology functions and how to operate the technological devices and systems [12].

3.0 Methodology

Manually searched on Google Scholar, Embase (Elsevier), for relevant studies. Articles were selected based on the keywords, published data, peer-reviewed literature, and professional discussions, Ministry of Health publication, and the World Health Organization database [13]. A systematic literature review was conducted in order to accurately answer the research question of the study, necessary information was collected from the previously done literature articles, and three steps were used to select the literature reviews suitable for this study. The literature searching strategy was conducted, followed by selection of the literature review and finally the findings. The searching strategy entailed searching for keywords and topics that are related to the research topic. Most of the peer reviewed articles identified for the study were searched and retrieved from the SpringerLink.

Once the potential literature review articles were identified, the researcher had to narrow down their search by adopting the inclusion and exclusion criteria during the selection process. All articles that were not written in English and were published before the year 2019 were excluded from the selection process. The quality assessment of the article was determined by relevance of the contents compared to the one in study [13].

4.0 Expected Contributions

The research will contribute to the health care sector of Saudi Arabia and this will also tell us the solution to the challenges which the government of Saudi Arabia has faced while using the technologies before and during the pandemic. Majority of the studies have focused on specific domains like investigating the effects and implications of technology in combating Covid-19 but fail to compare the technology that has been used during the pandemic and the one used before the pandemic, since the technological surge experienced globally was due to the outbreak of Covid-19 that has never been experienced before. This means that there is still a very big gap to be explored when it comes to analyzing the usage and impact of technology in combating the Covid-19 outbreak in the world as compared to the technology used before the Covid-19 outbreak [14]. This paper will be of value to all researchers and students who will be looking for more information regarding technological usage during the pandemic and the additional information presented in this paper will be of value and benefit to them.

5.0 Conclusion

A proposed framework of technology adoption in KSA Health Sector have served the public health in terms of video consultation, Surveillance system, contact notification, follow up and awareness. It is further concluded that as much as the Covid-19 pandemic have had a negative impact worldwide, it has also contributed to the technological surge that has been witnessed for the past few months globally. The technological surge was caused by the strict regulations and mitigation strategies that were implemented globally in order to curb the fast spread of the virus [14,15]. Technological surge was felt and experienced in almost all the sectors in the world, and it added value and benefits to the many business who were able to optimize the technological opportunity that presented itself to sustain themselves. Research shows that there has been an increased usage of internet and networks for the past 6 months and also there has been an increase on the number of online businesses since most businesses have shifted their businesses to e-commerce. Increase in the digitalization of medical services, e-commerce and e-learning globally was as a result of the pandemic that caused technological surge.

Covid-19 pandemic has been treated as a global emergency that has caused an enormous socioeconomic burden all over the world. Some of the well-resourced nations which are well developed with advanced healthcare systems were severely hit by the pandemic and some witnessed a huge number of causalities per day. Some of the countries include the European states such as France, Spain, Italy and Germany, China, United States, Russia and United Kingdom. Covid-19 pandemic also exerted a lot of pressure n developing counties such as countries in Africa and some like China, India and others this is due to the inadequate financial capabilities and poor health care facilities and resources [15].

The critical role played by the use of the numerous technologies in combating Covid-19 pandemic has highly contributed in controlling the spread of the pandemic globally. The use of technology has contributed in providing improved solutions, tracking infected patients. User privacy protection, medical supply chain performance, tracking of medical donations and keeping tabs of the day to day operations [15,16].

Some of the used technology such as the Blockchain, should be applied in such a way that network latency is reducible with a secure environment for data storage and data transmission of critical information. The ultimate combination of healthcare technologies with other emerging technologies, such as artificial intelligence, big data and Cloud computing, has the potential and capabilities of effectively handling deadly pandemic such as the Covid-19 outbreak. Integration of digital technology together with artificial intelligence and mass data have recently been a big deal in the global health especially with the ongoing fight against the COVID-19 pandemic. With support from MOH and national governments, these upcoming technology applications act as an alert system for aiding speedy contact tracing and notification as well as mass reach to the population [16]. Apart from technological use of mitigating and containing COVID-19, digital technology has also been used to complement and in some cases used to substitute the traditional approach to global health program implementation. However, as with any new applications and systems, extra measures should be taken and put in place such as privacy protection and skills training for healthcare specialists are necessary, this is for purpose of avoiding or minimizing blind spots which could overshadow the benefits.