Interview: COVID data researcher at Harvard has a message for Kashmir health workers

‘Valley doctors will tackle COVID head-on’; ‘need for proper data collection in J&K’

Srinagar: A Srinagar born doctor who is part of a major research project on coronavirus data patterns at Harvard Medical School has emphasised on the need for proper data collection and analysis in Kashmir too.

Dr Junaid Nabi, a public health researcher at Brigham and Women’s Hospital and Harvard Medical School in Boston U.S., is, in his latest project, working with ever-increasing and huge data sets of COVID-19 by harnessing machine learning and digital tools.

The team of researchers he is a part of aims to analyse data through automated algorithms to reveal patterns, trends, and associations that can help researchers take faster decisions in this crisis.  

In an exclusive interview with The Kashmir Monitor reporter Nisar Dharma, Dr Nabi spoke about his current project, how he sees the crisis unfolding in the next few months, and how the health workers and the authorities in Kashmir should approach this pandemic.

Nisar: So how and why is a doctor working with data?

Dr Junaid Nabi: That’s an interesting question. There are several reasons for this. One, with clinical information moving to electronic health records in many countries, having access and ability to investigate data provides a unique opportunity to study clinical questions that were not possible before.

For example, we can study outcomes and predictors in various diseases by studying how these diseases affected previous patients. Second, now with immense data analysis power like Artificial Intelligence and Machine Learning, we can (with decent precision) automate some of the tasks (administrative, etc) to deliver healthcare — which provides unique opportunities for future of healthcare. Data also provides opportunities to understand the “value” of healthcare services — by understanding costs better. These issues are necessary to comprehend if one wants to play an active role in the future of healthcare. There are many other reasons but these are some of the important ones for my interest and work in data analysis.

Nisar: In a recent article in Forbes, you mentioned about possible under-reporting of COVID-19 cases in Kashmir even though the government here says it has tested a bit more than 10,000 people. What is your take on the pace? And why do you think there is a possibility of under-reporting?

Dr Nabi: There seems to be a sustained effort to understand the burden of COVID-19 in Kashmir — and various agencies are working together, which is good. There are limitations in terms of health system capacity overall, but in my conversations with colleagues who are working on the ground in Kashmir, many health centres have it under control. The issue of understanding the true burden is global — and every country is struggling to calculate the actual numbers of infected people as testing is limited and we don’t know enough about the disease itself.

Nisar: Developing digital tools that harness big data and machine learning in analysing the Covid-19 crisis: Can you briefly explain your current project and the developments/findings in it so far?

Dr Nabi: Given the burden of disease (now COVID, but even otherwise) and the amount of research studies that are being produced and conducted, I have been thinking about how to harness the abilities of automated systems to understand broader patterns in these studies. Our effort (which is ongoing) aims to streamline this massive amount of research out there and develop tools to help scientists make more informed decisions.

The idea is that manual parsing of data at this scale is too burdensome and there is a need for options that can automate some of these tasks

Nisar: Where do you see this crisis heading in the next two months? Especially in Asian countries, and more so in places like Kashmir?

Dr Nabi: To be honest, it’s hard to tell — given the limited data we have at this point. Also, as different countries are at a different point on the curve, with different demographic factors and economic needs, it will have varying impact on countries in South Asia. I do think that policymakers need to use the most updated data available in their regions to make future policy decisions and that will require full participation of public health and state agencies. The timeline of the virus is hard to predict, but the response should be planned.

Given the unique geopolitical nature of Kashmir, it will be necessary to provide additional resources and protections to vulnerable communities, especially the ones in rural areas and the urban poor. Since overall capacity is limited in the health system in Kashmir, public health agencies will also benefit from investing in innovative modalities (kiosks and drive through testing) and approaches that utilize the already available infrastructure in Kashmir.

Nisar: Is social distancing the only way to fight COVID-19? Some health experts are suggesting herd immunity. What is your take on it?

Dr Nabi: Social distancing and lockdowns were needed at the time because the goal was to mitigate and suppress the transmission of COVID-19. But given the social and economic features of India —and Kashmir as well — it remains to be seen how long this can practically work.

Regarding herd immunity, it’s still a controversial approach. For example, researchers from the Princeton have recommended that India should lift strict lockdown and allow younger people (<60 years) to return to regular routine. But this doesn’t mean that social distancing and mask usage will be abandoned or large gatherings will be allowed—but they need to be regulated. Even after reopening, the focus needs to be more aggressive testing and isolation of cases. The data so far is limited and the authorities need to consider political and economic factors to take such decisions. Countries like Sweden have done it but U.K. hasn’t been able to.

Nisar: Analysing huge COVID-19 data piling up each day is a big challenge. Should government or institutions of medicine and research in J&K nominate people specifically for this purpose? And is setting up such a system, howsoever basic it may be, possible in a limited period?

Dr Nabi: Yes, collecting as much data as possible is necessary and if the J&K government can do that, it will be immensely useful. I cannot comment on the process of how they should go about it, since that will need administrative coordination, but this kind of data will be helpful for clinical research as well as public health policy making in the future. It will be difficult in this time to setup a new system but even if basic methods/procedures of documentation are adopted, much of useful data can be gathered.

Nisar: Since you have worked in both impoverished regions and medically advanced countries, what would be your suggestions to our health workers who are dealing with COVID-19 with limited medical and financial resources in Kashmir? Should they look at the huge spikes in cases and deaths in Europe and U.S. and prepare themselves for it? Or should they take it one day at a time?

Dr Nabi: First of all, I have much respect for health workers in Kashmir — my father was a physician who practiced in Kashmir and I know how difficult it can be to work within a system that has limited resources.

What I also know is that they will tackle this challenge head on and help our community. My advice would be to not get disheartened. Different countries will be impacted in varying amounts — we already saw that in Italy with Germany. The course of the disease in India will also be unique — and so far the data backs that.

I would suggest a couple of things for health workers in Kashmir — one: be kind to yourself; the community needs you more than ever, so you need to take care of yourself (physically and mentally); two: just because other countries are having worse outcomes does not guarantee the same will happen in Kashmir, so take the challenge one day at a time but prepare yourself in case the situation changes; three: play an active role in the community and lead by example—whether it’s giving information to the public or encouraging health practices (masks, etc) or helping contain the spread of misinformation on social media channels; four: read up as much as you can on treatment guidelines (NIH recently published a living document) so you are prepared for an unpredictable event.

Nisar: In your current project, is the data that you work with limited to a certain geography or set of people? If yes, do you plan to include more varied datasets in future (for instance patient data from J&K)?

Dr Nabi: That’s an important observation. The data we work with can be of different types—and in most scenarios the findings from such data can be useful throughout the world, because we investigate clinical questions. For example, when we investigate how delay in treatment can lead to worse outcomes for a certain disease—and in many cases it does—that information is helpful to many countries, because they can use this information to create policies that enable patients to access the healthcare system on time. My current work is mostly specific to US datasets, because every country has different rules for how they allow data use, but many findings (especially in clinical studies) can help patients in Kashmir as they are intended to improve healthcare quality in general.

Dr Junaid Nabi is originally from downtown Srinagar. He is currently a public health researcher at Harvard University, where his work focuses on disparities in surgical care, international health policy, bioethics, and innovations in health care. He is also Senior Fellow at The Aspen Institute, Washington, D.C. Dr Nabi received his medical doctorate from Dhaka University and his MPH from Harvard University. He tweets @JunaidNabiMD