Original Article Integration of multiple geospatial applications and intelligence for responding to COVID-19 in Ghana Alex B. Owusu1, Seth K. Afagbedzi2, Delia A. Bandoh3*, Joseph A. Frimpong3, Isaac N. Kissiedu1, Ben E. Aikins1, Richmond Hinneh1 and Ernest Kenu3 Ghana Med J 2021; 55(2) supplement: 10-20 doi: http://dx.doi.org/10.4314/gmj.v55i2s.3 1Department of Geography and Resource Development, University of Ghana, Legon, Accra 2 Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana 3GFELTP, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana Corresponding author: Delia Akosua Bandoh E-mail: deliabandoh@st.edu.gh Conflict of interest: None declared SUMMARY Objective: We describe the use of integrated geospatial applications for the provision of access to timely and accurate data on samples, visualisation of Spatio-temporal patterns of cases and effective communication between field sample collectors, testing laboratories, Regional Health directors and Government Decision Makers. Design: This study describes how an integrated geospatial platform based on case location and intelligence was de- veloped and used for effective COVID-19 response during the initial stages of COVID-19 in Ghana. Data Source: Collector for ArcGIS, ArcGIS Survey123 Main outcome measure: successful development and deployment of integrated geospatial applications and analytics. Results: The Collector for ArcGIS app was customised to collect COVID-19 positive cases location information. Survey 123 was introduced as a COVID-19 contact tracing application to digitise the case-based forms and provide real-time results from the laboratories to GHS and other stakeholders. The laboratory backend allowed the testing laboratories access to specific information about each patient (sample) collected by the fieldworkers. The regional supervisors’ backend web application provided accessing test results for confidentiality and timely communication of results. Conclusion: Geospatial platforms were successfully established in Ghana to provide timely results to Regional Health Directors and Government decision-makers. This helped to improve the timeliness of response and contact tracing at the district level. Keywords: ArcGIS, geospatial, COVID-19, pandemic, distribution Funding: The development and deployment of the application, COVID-19 pandemic response and writing workshop by the Ghana Field Epidemiology and Laboratory Training Programme (GFELTP) was supported with funding from President Malaria Initiative – CDC, and Korea International Cooperation Agency (on CDC CoAg 6NU2GGH001876) through AFENET and the United States Agency for International Development (USAID) through Results for Devel- opment (R4D). INTRODUCTION Coronavirus disease 2019 (COVID-19), also known as The WHO, on March 11, declared COVID -19 a pan- severe acute respiratory syndrome coronavirus 2 (SARS- demic, and since then, the virus has spread to all six con- CoV-2) was first detected as an outbreak of respiratory tinents and 213 countries.5 The virus has infected more illness in Wuhan City, Hubei Province, China.1 China than 23 million people globally, with a death toll of more was the first country to report to the World Health Organ- than 800,000 as of August 2020.6 The world has previ- ization (WHO) on December 31, 2019 that pneumonia of ously experienced other coronaviruses such as Severe unknown cause. Subsequently, Thailand, and Japan noti- Acute Respiratory Syndrome (SARS) reported in China fied WHO of confirmed cases of novel coronavirus in 2003 and the Middle East Respiratory Virus (MERS known as 2019-nCoV.2 The WHO declared the COVID- CoV) reported in Saudi Arabia in 2012.7 19 outbreak a public health emergency of international concern on January 30, 2020.3,4 10 www.ghanamedj.org Volume 55 Number 2 supplement June 2021 Copyright © The Author(s). This is an Open Access article under the CC BY license. Original Article At the initial stages of the pandemic, countries adopted ited coverage across the country and some in-depth geo- various response strategies, including geospatial ap- spatial analysis, which would be relevant for key re- proaches to prevent the further spread of the virus and sponse strategies. As the outbreak progressed, there was mitigate its effects.8 China’s first phase of public health a need to expand the geospatial capacities of the SOR- response to COVID-19 focused on short-term measures MAS platform and acquire additional logistics to expand to stop the virus from spreading from Hubei to the rest of its reach across the country. the country and included “extreme lockdowns” and re- gional quarantines.9 As a stopgap measure, the School of Public Health (SPH), Ghana Field Epidemiology and Laboratory Train- China, among other strategies, has implemented a differ- ing Program (FELTP), and the Department of Geography entiated, location-specific response to prevent the spread and Resource Development at the University of Ghana so that public health measures are tailored to the differing developed a system to complement the existing structures realities on the ground. For example, measures adopted as the challenges identified with the rollout of SORMAS in Wuhan were very different from those applied in other were being addressed. These measures were to help pro- places such as Chengdu or Shanghai.10 vide geospatial data on cases and provide nationwide coverage in the meantime. Consequently, a geospatial In Ghana, the first two coronavirus cases were reported mobile application was developed to demonstrate the on March 12th, 2020, and as of 30th March 2020, the total power of integrating multiple geospatial applications confirmed COVID-19 cases were 152, with five deaths.11 with spatial intelligence capabilities in effectively man- Majority of the cases were concentrated in Accra and Ku- aging the COVID-19 situation in Ghana. masi metropolitan areas, the two most populated cities of the country. On March 30th 2020, the government of This paper demonstrates the use of an integrated geospa- Ghana imposed a partial lockdown of Accra, Kasoa and tial application and analytics via cloud system for the Kumasi as additional measures to those adopted two provision of access to timely and accurate data on sam- weeks earlier, which included a ban on all public gather- ples, visualisation of the Spatio-temporal pattern of the ings, closure of schools, churches, mosques, other places case and effective communication between field sample of worship and a mandatory quarantine of all travellers collectors, testing laboratories, Regional Health directors that arrived in the country 48hrs before the closure of the and Government Decision Makers. country’s borders.12,13 Announcing the lockdown, the President indicated that his government had five (5) key METHODS objectives to combat the pandemic in Ghana, and these The reference point for application were to; 1. Limit and stop the spread of the virus; 2. Con- The application was initially developed based on gaps tain the spread of the virus; 3. Provide adequate care for identified in the response at the two epicentres for the the sick; 4. Limit the impact of the virus on social and pandemic in Ghana, that is, Greater Accra Metropolitan economic life; 5. Inspire the expansion of the domestic Area (GAMA) and Greater Kumasi Metropolitan Area capability and deepen self-reliance. All these measures (GKMA), hence referred to as COVID-19 hotspots (Fig- were aimed at limiting the spread of the virus. ure 1). Since the detection of Ghana’s first case on March 12th, Design 2020, several strategies have been adopted by the health The application was designed by integrating a geospatial authorities to control the epidemic. Ghana Health Service platform based on case location and intelligence using (GHS), the Ministry of Health (MoH) 's implementing ArcGIS and Survey 123. body, was tasked with establishing effective mechanisms for disease surveillance, prevention, and control and Description of the platform leading the COVID-19 response.14 One key strategy of The platform provided an opportunity to integrate four GHS response is the “3 Ts approach” - Testing, Tracing, different but complementary applications for contact and Treatment and provision of data from this strategy in tracing activities, receiving, testing, reporting test results, real-time. GHS, therefore, rolled out the “SORMAS” visualisation of sample collection patterns and Spatio- (Surveillance Outbreak Response Management & Anal- temporal patterns of cases. The platform had unique ysis System) application as a national electronic real-time functional parts which included: Geospatial mobile app platform for surveillance and outbreak response.15 An for the data collection on the field; Real-time spatial dis- earlier assessment of SORMAS to determine its readi- tribution of cases; Portal for labs to update test results; ness to be used as a response tool for the COVID-19 out- Portal for district supervisors to monitor work of field break in Ghana revealed some challenges, including lim- staff; Portal for regional directors and district directors to 11 www.ghanamedj.org Volume 55 Number 2 supplement June 2021 Copyright © The Author(s). This is an Open Access article under the CC BY license. Original Article visualise the distribution of the cases and download line of the President of the Republic of Ghana, which enabled list and Barcode scanner for sample labelling and track- the Presidency (WAR ROOM) to have real-time access ing. There was also an interactive dashboard in the office to what was happening in the field. Figure 1 Map of Ghana with Ashanti and Greater Accra Regions Inset and location of COVID 19 cases as of 31st March 2020 These different but complementary applications were: to facilitate field data collection in the form of a digital Collector for ArcGIS questionnaire to collect location information.17 The sur- The Collector for ArcGIS developed by Environmental vey 123 supports Android, iOS, and Windows operating Systems Research Institute (ESRI) is a Geographic Infor- systems. The survey 123 platform enables users to cus- mation System (GIS) enabled mobile application that tomise digital forms or questionnaires to match a paper works on Android and iOS Operating Systems and can one. collect the location and attribute data about any phenom- enon of interest.16 In this case, the app was customised Survey 123 was introduced as a COVID-19 contact trac- to collect COVID-19 positive cases location information. ing application to digitise the case-based forms and pro- ArcGIS Online served as the data storage repository vide real-time results from the laboratories to GHS and whenever data was submitted from the Collector app, other stakeholders. The primary users were the field making it possible to get the GIS data in real-time for vis- workers and health facilities. The field workers included ualisation and analysis like heat maps and risk zones. The contact tracers and Community Surveillance, Team. The ArcGIS Collector uses a spatial layer with attribute infor- application was installed on mobile devices, which in this mation either developed in ArcMap, ArcGIS Pro, or even situation was a tablet – Samsung Tablet 10.8 – with an online. The Spatial layer enables users to see the location Android operation system. Each team logged into this or point of interest, whereas the attribute information mobile application on a tablet and connected to the cus- usually displays all sorts of information collected from tomised ArcGIS Survey 123 for the ArcGIS platform. the field. The backend database contained the case-based investi- gation form, designed and approved for use by the GHS. ArcGIS Survey 123 The ArcGIS Survey 123, just like the Collector for Laboratory Backend Web Application ArcGIS, was a data collection system developed by ESRI 12 www.ghanamedj.org Volume 55 Number 2 supplement June 2021 Copyright © The Author(s). This is an Open Access article under the CC BY license. Original Article The laboratory backend was a secured web portal capable and values depending on the nature of data, and the result of providing real-time access to the laboratory data.18 The demanded from visuals.19 This system component is con- application allowed the testing laboratories access to spe- nected to the data feed from the ArcGIS collector and cific information about each patient (sample) collected ArcGIS Survey 123 for contact tracing applications to the by the fieldworkers. The labs received samples from the President’s war room. Data was updated immediately af- field with tagged barcodes. With the help of barcode ter information was uploaded on the field. The Dash- scanners, samples were scanned to retrieve their infor- board displayed the various recorded cases in the form of mation in the database. The information was then up- points representing their locations. To simplify the infor- dated, marked as received, and test results updated to en- mation on the Dashboard for decision-makers to see what sure a seamless flow of samples from the field to the la- was happening, various sections were created to display boratories. It had a visualisation map that showed the lo- different forms of infographics. cations where the samples were collected and their test results status. The structure of the related tables of the application’s database Regional Supervisors backend web applications The preparation of the spatial and attribute layer was This application has a similar structure and functionali- done in ArcGIS Pro. In ArcGIS Pro, a database was cre- ties as the lab, except it is read-only and downloadable. ated for households. Point features were used to represent It was mainly used for accessing test results for confiden- households. To generate a form of decision tree to deter- tiality and timely communication of results. Regional Di- mine the first case in a household and its contacts and rectors of Health and Regional Supervisors of the household indication, a relationship was built as part of COVID-19 program, appointed by Ghana Health Ser- the database to link household members to the first case vices, were the primary target. Hence, 16 dedicated web who would then serve as contacts. The back end of the portals were created for regional directors and supervi- applications was the related table showing sample and re- sors to access and download the lab test results of their lated samples (see Figure 2). Selecting a sample from the respective regions. map shows its related tables. Figure 2 shows how indi- viduals are mapped or sampled, and the design of the re- Interactive Dashboard in the office of the President lated tables for contact tracing enhanced contact tracing The ArcGIS Dashboard is a visualising platform that can and community surveillance. display diverse infographics, including graphs, charts, •Primary contact 1 - household •primary contact 1 .....n Primary case •Secondary Contact and Household Secondary •Secondary contact 1 .... n Case •Tertiary Contact and Household Secondary •tertiary contact 1 ...n case •Do not remeber of any link with case Community Case Figure 2 Contact Tracing and Community Case Tracking Relational Tables On the household layer, a ‘GlobalID’ is generated by de- household included; the date that the household was vis- fault for every single record within this layer. The attrib- ited, region, district, community, name of household ute information to be collected field workers on the (Household owner/head name), telephone number of the 13 www.ghanamedj.org Volume 55 Number 2 supplement June 2021 Copyright © The Author(s). This is an Open Access article under the CC BY license. Original Article house owner, number of persons in the household, num- throughout the study. The data collected is only available ber of rooms available in the household. On the other to the administrator of the database. Once the data has hand, an attribute table named ‘individuals’ was created been synced, the field data collectors don’t have access. to store the information on members of the household. The data is anonymised before it is shared. Data was kept Information to be collected by the field workers included on password-protected computers and was only accessed the names of individuals in the household, age of the in- by authorised persons. dividual, the gender, telephone number, travel status, health condition, whether or not a sample was taken in RESULTS that house, the date that the sample was taken, laboratory Geospatial Applications for COVID-19 Data Collec- results if available. These parameters appeared on the tion Collector for ArcGIS as a form for field workers to fill. The Geospatial mobile app for field data collection- Fig- To ensure data quality, some of these questions were ure 3 shows ArcGIS Collector and Survey 123 applica- made mandatory fields for sample collectors. Failure to tions electronically collected information contained in populate these mandatory fields would not enable data to the case-based forms developed by GHS for COVID-19 be submitted from the field. For the spatial layer and the data collection. In addition to this, GPS locations were attribute table to communicate, such that when a user collected for each sample. The applications also collected clicks on a point, all other members related to that house- information on suspected and potential cases. This infor- hold appears, a foreign key which in this case was the mation was sent to the laboratory backend for updating Global ID of the household, was introduced in the rela- of tests results. Figure 3 shows the interface of the geo- tionship enabling the spatial data to link up with a piece spatial contact tracing a mobile application with the Elec- of corresponding attribute information. A one-to-many tronic Case-based Form relationship was enabled, making it possible for more than one individual to be linked to a household. The Ge- The electronic case-based investigation form was catego- odatabase, which contains the household layer, the indi- rised into five main sub-sections, with each section con- vidual attribute table and the relationship class, was then taining several questions. It started with survey infor- published to ArcGIS Online. A web map was created in mation, followed by patient personal information, then ArcGIS online to enable the field team to access the cre- the clinical information, exposure and travel information ated layers on the collector for ArcGIS. With Android over the last 14 days before the survey and information tablets, sample collectors were able to access these layers on sample collection. The fieldworkers had the chance to on the field. The accuracy of locations was set to 10m so edit and correct errors within time before the physical that the system would not accept anything above 10m. sample got to the labs. Ethical consideration Figure 3 shows case locations mapped immediately on Approval for the study was obtained from Ghana Health ArcGIS Online, ready for analysis and interpretation after Service Ethics Review Committee (GHS-ERC the fieldworkers submitted their data. 006/05/20). The confidentiality of data was maintained Figure 3 Mapped cases from the ArcGIS collector 14 www.ghanamedj.org Volume 55 Number 2 supplement June 2021 Copyright © The Author(s). This is an Open Access article under the CC BY license. Original Article Figure 4 shows sample points and attributes from ArcGIS the number of samples, and field staff could count the en- Survey 123. Immediately the field staff submit infor- tries of all sent data as shown below. Necessary correc- mation entered into the electronic CASE_INVESTIGA- tions could also be made if any, and the data re-submit- TION_FORM. The laboratories receive it in real-time. ted. The fieldworker could crosscheck data submitted against Figure 4 Mapped sample point and attributes from ArcGIS Survey 123 Laboratory Backend Web Application where the samples were collected and their test results Figure 6 shows the user interface of the lab backend web status. The sample points that appeared red were results application. The labs receive samples from the field with that tested positive for COVID-19, and the green col- barcodes labelled on the samples. Barcode reading scan- oured sample points were negative. Sample points pend- ners were used to scan the barcodes on the sample. This ing confirmation of test results were coloured in blue query field sample data in the database and mark as re- whilst invalid sample points were coloured in black. ceived and update test results. The application has a vis- ualisation map and a meaningful display of the locations Figure 5 User interface of the lab backend web application 15 www.ghanamedj.org Volume 55 Number 2 supplement June 2021 Copyright © The Author(s). This is an Open Access article under the CC BY license. Original Article Figure 6 shows the regional directors and supervisors’ The Regional Directors were able to down the line list of portal and data. This interface provides the line list of in- the patients and consequently, inform them about the out- dividuals whose samples were taken, including the per- come of their test sonal, travel, clinical and test details and results. Figure 6: Regional directors’ and supervisors’ portal Figure 7 Regional Dashboard with analytics On the Dashboard, Figure 7 was the main map area which whether the sample was from contact tracing, hospital or displayed the various locations of all cases recorded in travelers who were placed under 14 days quarantine on real-time after input from the lab. This symptoms status arriving in Ghana. The Dashboard provided charts and section displayed the analysed percentage of sympto- graphs for more visual effects and display including, matic and asymptomatic cases recorded, the source of daily progression, regional breakdown, deaths, recovered sample section which dealt with the source of sample and active case through which the case was tested as positive, that is, 16 www.ghanamedj.org Volume 55 Number 2 supplement June 2021 Copyright © The Author(s). This is an Open Access article under the CC BY license. Original Article Map visualisation of integrated multiple geospatial The green colour of the sample changes to blue when a application’s output sample is confirmed positive see Figure 9. The yellow The integration of multiple geospatial applications re- symbol in the legend shows the geographic locations of sulted in mapping and visualisation of sample collection the COVID-19 cases before the lockdown. Close to 120 points and COVID 19 cases during the enhanced contact cases were mapped in some districts in Greater for the tracing when the partial lockdown was imposed on enhanced contact tracing. The blue symbols denote cases Greater Accra and Kumasi Metropolitan areas. Figure 8 found from the samples collected during the enhanced shows locations of initial COVID-19 cases denoted by contact tracing. By the end of April more than 2000 cases the red dot with 2km buffer around each. With the en- were found from the samples collected. These were sam- hanced contact tracing, field workers were instructed to ples collected from the households tested and were found collect samples of household members within the 2km of to be positive. The red symbol denotes post lockdown the case. The green dot denotes samples collected for cases when the enhanced contact tracing eased. Fewer testing during the enhanced contact tracing (Figure 9). cases were found compared to the lockdown period. Figure 8 Two km buffer of initial COVID-19 cases and sample points during enhanced testing Figure 9 Spot map of COVID-19 cases from pre-lockdown to post lockdown period 17 www.ghanamedj.org Volume 55 Number 2 supplement June 2021 Copyright © The Author(s). This is an Open Access article under the CC BY license. Original Article DISCUSSION health directorates and policymakers. This ensures that Using various measures to help contain the spread of all stakeholders have the right information communi- COVID-19 in the at-risk zones or communities requires cated to them on time for accurate decisions. The Re- an approach to document the real-time location of the gional Supervisors backend web applications created al- cases. This work describes the use of integrated geospa- lowed patient results to be assessed by the regional health tial applications in responding to COVID-19 in Ghana. directorates. Timely results released to the directorate aided in identifying positives in the shortest possible time During the COVID-19 pandemic, geographical infor- and communicating results to patients. This was because mation systems (GIS) were deployed in various settings the application provided real-time tracking location and in responding to the pandemic.20 The deployment of in- status of tested samples. This procedure was important in tegrated GIS applications in the Ghanaian context played decision-making and improved data transparency and as- a major role in identifying the hotspots of the infection, sisted in information dissemination.29 which helped the country prioritise its response strategies for early detection and control of the infection. Again, the interactive dashboards for policymakers com- bined spatial analytics capabilities with time filters to Given the nature of COVID-19 and its way of spread, lo- view test results on country-wide, regional and district cation information plays a critical role in the response. bases. This facilitated easy understanding of results by The collector for ArcGIS was customised to support the the Government and other decision-makers. The use of location information of COVID-19 cases in Ghana. This real-time data and coordination of information enabled aided decision-makers to know which locations or com- policymakers to adjust management strategies in near munities were vulnerable to the disease, which neigh- real-time within the COVID-19 hotspot zones identified bourhoods needed more contact tracers, and which ones in the country. were newly infected. In other settings, GIS has been used to collect data for decision making in different areas, The application improved the communication of test re- even in outbreaks and COVID-19.20-25 sults in terms of accuracy and timeliness. The testing labs scan using barcode readers and enter the details of the in- An advantage of using the ArcGIS application is the data dividual test results with many pre-coded options. Time repository available as the ArcGIS Online. This made the for typing results improved, the accuracy of results com- real-time visualisation of data submitted with the ArcGIS municated improved while regional directors and Deci- collector possible. Real-time visualisation of the GIS data sion Makers Dashboard automatically updated instantly is very important in decision-making and managing hu- with the entered lab results. This allows regional Direc- man lives in different countries.24,26,27 tors to access test results of individuals patients, includ- ing their location, as soon as the laboratories enter the re- Data management remains a challenge, especially in a sults. The results show that communication through map- 29 pandemic situation where the number of cases continues based dashboards offers accessible information. to rise with time. It was difficult filling out hard copy case-based investigation forms completely for each sam- The deployment of this integrated system helped map and ple taken on the field. Pertinent information was there- identify case locations, contact tracing locations, and the fore lost. With the introduction of a customised applica- characteristics of neighbourhoods and communities tion based on Survey 123 for ArcGIS, case-based inves- where the cases were being reported. Based on this appli- tigation forms were completed electronically. Samples cation, it was observed that all the initial cases were lo- taken from the field were labelled and scanned with bar- cated in Greater Accra Metropolitan Area (GAMA) and codes into the online application system. Relatively, this Greater Kumasi Metropolitan Area (GKMA). Again, it reduced the length of time used in completing the forms was also observed that all the initial cases were in high manually. The possibility of missing or rain destroying income residential areas of Accra Metro and Ayawaso case-based forms were completely avoided. This applica- West Wogon. The objective of the enhanced contact tion enhanced the receiving and validation of samples by tracing during the lockdown was to identify all possible the testing laboratories. This approach was reported to be cases through contact with initial cases, isolate and treat an accurate, timely and convenient field data collection them to reduce the spread of the COVID-19 disease. The during emergencies because it ensures prompt manage- map visualisation of integrated multiple geospatial appli- ment and quick response.28 cation output (Figure 9) shows that many cases that oth- erwise would have been left in the communities to infect To effectively respond to an outbreak, there is the need other people have been identified and isolated or treated. to have a system that interconnects the field, laboratory, Hence, the lockdown and enhance contact tracing used by Ghana have largely achieved their objectives. 18 www.ghanamedj.org Volume 55 Number 2 supplement June 2021 Copyright © The Author(s). This is an Open Access article under the CC BY license. Original Article Some limitations encountered during the study were the 2. WHO. Addendum to Fact Sheet 15 on National Im- phased approach used in implementation of the various plementation Measures for the International Health applications. For each application, contact tracers and Regulations 2005 (IHR) COVID-19 as a Public health workers needed to be trained on how to be used. Health Emergency of International Concern Due to the little time they had on their hands, brief train- (PHEIC) under the IHR. WHO. Geneva. 2020. ing sessions were held for them. This led to initial results Available at: https://extranet.who.int/sph/sites/de- with some lapses and gaps such as inability to sync the fault/files/document-library/docu- data properly, inaccurate geospatial coordinates and dif- ment/FS15A_IHR_COVID19_EN_MAY_2020.pdf ficulty in completing some of the fields on the case-based . Accessed: July 19, 2020. form. Supervisors were assigned to each district to pro- 3. WHO. Rolling updates on coronavirus disease vide supportive supervision and any technical assistance (COVID-19). WHO. Geneva. 2020. Available at needed to solve this problem. Again, all issues seen with https://www.who.int/emergencies/diseases/novel- the data was relayed to supervisors who followed upon coronavirus-2019/events-as-they-happen. Accessed: them to be correctly captured. July 2, 2020. 4. Ramzy A, McNeil DG. W.H.O. Declares Global Implementing the lockdown with extreme measures of Emergency as Wuhan Coronavirus Spreads. The restriction in mobility, social distancing, closure of New York Times. New York. 2020. Available at schools, banning of mass gathering, isolation and quar- https://www.nytimes.com/2020/01/30/health/coro- antine helped undertake the enhanced contact tracing in navirus-world-health-organization.html. Accessed: the various communities. During the period (Figures 9 July 2, 2020. &10), more cases were detected, isolated and treated; 5. Worldometer. Countries where COVID-19 has hence, the aim of the lockdown was large achieved31,32 spread. 2020.Available at https://www.worldome- ters.info/coronavirus/countries-where-coronavirus- CONCLUSION has-spread/. July 02, 202; Accessed: July 2, 2020 This study describes how the integration of multiple ge- 6. WHO. WHO Coronavirus Disease (COVID-19) ospatial applications with spatial intelligence capabilities Dashboard. WHO. Geneva. 2020. Available at effectively responded to COVID-19 in Ghana during the https://covid19.who.int/?gclid=CjwKCAjwi_b3BR early stages of the pandemic (from March to the end of AGEiwAemPNU389V27iQ9nbQ1bGjRge8qW1sB April 2020). Specifically, the study has demonstrated BhDY- how the integration of geospatial applications was used GrZO1UbKltTSHoMXdH0Ke35RoCWngQAvD_ for effective communication between contact tracers, BwE July 02, 2020. Accessed: July 2020. field sample collectors, testing laboratories, Regional 7. WHO. Middle East respiratory syndrome corona- Health directors and Government Decision Makers. This virus (MERS-CoV). WHO. Geneva. 2019. Available work demonstrates that an integrated geospatial system at https://www.who.int/news-room/fact-sheets/de- can create a network between the field, laboratory, health tail/middle-east-respiratory-syndrome-coronavirus- workers and decision-makers to effectively respond to an (mers-cov). Accessed: July 02, 2020. outbreak. 8. Ian Bremmer. The Best Global Responses to COVID-19 Pandemic. Time. California. 2020. ACKNOWLEDGEMENTS Available at: https://time.com/5851633/best-global- We wish to thank all contact tracing teams and laboratory responses-covid-19/. Accessed: July 15, 2020 staff teams for their corporation and time. We wish to 9. WHO. 2020. China shows COVID-19 responses thank all community members, contact tracing teams, must be tailored to the local context. WHO. Geneva. case management teams, health staff, and others we 2020. Available at worked with for their corporation and time, to the other :https://www.euro.who.int/en/health-topics/health- faculty who supported in this activity, Dr. Mary Amoako- emergencies/coronavirus-covid- Coleman, Dr. Benedict Calys-Tagoe, Ms. Magdalene 19/news/news/2020/4/china-shows-covid-19-re- Odikro, and Ms. Benedicta Atsu. We are grateful for your sponses-must-be-tailored-to-the-local-context; Ac- time and contributions. cessed: July 02, 20202. 10. TrialSite News, 2020. China’s Response to COVID- 19: The Good, the Bad, and the Ugly March 30. Tri- REFERENCES alSite News. Salt Lake City. 2020. Available at: 1. CDC. Novel Coronavirus, Wuhan, China. CDC. At- https://www.trialsitenews.com/chinas-response-to- lanta. 2019. Available at https://www.cdc.gov/coro- covid-19-the-good-the-bad-and-the-ugly/ Ac- navirus/2019-ncov/about/index.html. January 26, cessed: July 02, 2020 2020; 19 www.ghanamedj.org Volume 55 Number 2 supplement June 2021 Copyright © The Author(s). This is an Open Access article under the CC BY license. Original Article 11. GHS. Situation Update, Confirmed COVID-19 17. ESRI. ArcGIS Survey123. 2020. Available Cases In Ghana. GHS. 2020. Available at: at:https://survey123.arcgis.com/. Accessed: July 21, https://ghanahealthservice.org/covid19/archive.php. 2020 Accessed: July 15, 2020. 18. ESRI. Portal for ArcGIS 101. 2020. Available at: 12. Kenu E, Frimpong JA, Koram KA. Responding to https://www.esri.com/about/newsroom/arcuser/por- COVID-19 pandemic in Ghana. Ghana Med J 2020; tal-for-arcgis-101/. Accessed: July 21, 2020 54(2):72-73DOI: 19. ESRI. ArcGIS Dashboards. 2020. Available at: http://dx.doi.org/10.4314/gmj.v54i2.1 Available at: https://www.esriuk.com/en-gb/arcgis/prod- http://www.ghanamedj.org/arti- ucts/arcgis-dashboards/over- cles/June2020/1%20Editorial.pdf.Accessed:July 19, view#:~:text=ArcGIS%20Dashboards%20ena- 2020. bles%20users%20to,visualisa- 13. Owusu-Fordjour C, Koomson CK, Hanson D. The tions%20on%20a%20sin- impact of Covid-19 on learning-the perspective of gle%20screen.&text=Dashboards%20are%20essen- the Ghanaian student. European Journal of Educa- tial%20information%20products,compo- tion Studies. 2020:7;3. nent%20to%20your%20geospatial%20infrastruc- 14. Ghana Health Service. Background of Ghana Health ture. Accessed. July 21, 2020. Service. GHS. Accra. 2020. https://ghana- 20. Boulos MNK, Geraghty EM. Geographical tracking healthservice.org/ghs-subcate- and mapping of coronavirus disease COVID-19/se- gory.php?cid=2&scid=42. Accessed July 19, 2020. vere acute respiratory syndrome coronavirus 2 15. HZI, 2019. Helmholtz Centre for Infection Research. (SARS-CoV-2) epidemic and associated events Available at: https://www.helmholtz-hzi.de/en/. Ac- around the world: how 21st century GIS technolo- cessed: September 2019 gies are supporting the global fight against outbreaks 16. ESRI. ArcGIS Collector. 2020. Available at: and epidemics. Int. J. Health Geogr. 2020: 19(1); 8, https://www.esri.com/en-us/arcgis/products/arcgis- s12942-020-00202–8. doi: 10.1186/s12942-020- collector/overview. Accessed: July 20, 2020 00202-8. 21. Mbuh M, Metzger P, Brandt P, Fika K, Slinkey M. 26. Gong J, Geng J, Chen Z. Real-time GIS data model Application of real-time GIS analytics to support and sensor web service platform for environmental spatial intelligent decision-making in the era of big data management. Int. J. Health Geogr. 2015:14;2. data for smart cities. EAI Endorsed Trans. Smart Cit- doi: 10.1186/1476-072X-14-2. ies 2019: 4(9). Accessed: Jul. 27, 2020. [Online]. 27. Lwin K, Hashimoto M, Murayama Y. Real-Time Available: https://eudl.eu/doi/10.4108/eai.26-6- Geospatial Data Collection and Visualization with 2018.162219. Smartphone. J. Geogr. Inf. Syst. 2014: (06)02; 99– 22. Robin TA, Khan MA, Rahman Sk T, Karim A, Ibne 108, 2014, doi: 10.4236/jgis.2014.62011. I, et al., ‘Using spatial analysis and GIS to improve 28. Kamel Boulos MN, Geraghty EM. Geographical planning and resource allocation in a rural district of tracking and mapping of coronavirus disease Bangladesh’, BMJ Glob. Health 2019: 4(Suppl 5) p. COVID-19/severe acute respiratory syndrome coro- e000832, Jun. 2019, doi: 10.1136/bmjgh-2018- navirus 2 (SARS-CoV-2) epidemic and associated 000832. events around the world: how 21st century GIS tech- 23. Ozdilek O, Seker DZ, ‘A Web-Based Application nologies are supporting the global fight against out- For Real-Time GIS’, p. 5. XXth ISPRS Congress, Is- breaks and epidemics’, Int. J. Health Ge- tanbul, Turkey, 12-23 July, 2004, pp. 1-5. ogr.2020:19(1);8doi: 10.1186/s12942-020-00202-8. 24. Anugrah W, Suryono S, Endro Suseno J. Real-time 29. Kraemer MUG, Yang C-H, Gutierrez B, et al. The Geographic Information System (GIS) for Monitor- effect of human mobility and control measures on ing the Area of Potential Water Level Using Rule the COVID-19 epidemic in China. Science. Based System’, E3S Web Conf., 2018:31;11019. doi: 2020;368:493–7. 10.1051/e3sconf/20183111019. 30. Prem K, Liu Y, Russell TW, et al. The effect of con- 25. Dabrowski J, Kulawiak M, Moszynski M, Bruniecki trol strategies to reduce social mixing on outcomes K, Kaminski L, Chybicki A, Stepnowski A. Real- of the COVID-19 epidemic in Wuhan, China: a mod- time Web-based GIS for Analysis, Visualization and elling study. Lancet Public Health. 2020; published Integration of Marine Environment Data. IF&GIS online March 25. https://doi.org/10.1016/S2468- 2009; 277–288, doi: 10.1007/978-3-642-00304- 2667(20)30073-6 2_19. 20 www.ghanamedj.org Volume 55 Number 2 supplement June 2021 Copyright © The Author(s). This is an Open Access article under the CC BY license.