JOURNAL OF LATEX CLASS FILES, VOL. , NO.
, MONTH
Post COVID-19 Intelligent Public Healthcare
Management– The Next Frontier to Handle
Epidemic Outbreaks
Abstract—Epidemic outbreaks are collective effects of ongoing
globalization, urbanisation, population mobility, climate change,
demographical change and evolution of newer strains of infec-
tious agents that result in high morbidity, mortality and huge
financial loss, such as COVID-19. Thus, the early prediction of the
emergence of a disease can play a pivotal role to prevent a disease
to become epidemic. In this paper, our prime focus is to propose
a novel and smart machine learning based advanced model for
public healthcare to reduce and control epidemic outbreaks.
Collective knowledge from interconnected disciplines, shared
data repository, and diverse roles have been embedded into the
proposed framework. The model includes machine learning as a
deployable method for predicting early risk factors using data
related to ecological, epidemiological, socio-economic and other
factors. An evaluation based on actual COVID-19 related data
demonstrates that early prediction of the epidemic outbreak can
aid the healthcare authority to take appropriate steps to combat
epidemics in early-stage and prevent lives and financial losses
globally.
Index Terms—Epidemic, outbreak, disease control, early pre-
diction, disease management, global health
I. I NTRODUCTION
Epidemic outbreaks can pose a noteworthy threat to human
health. The spread of infectious diseases like COVID-19 are
more extensive and expeditious than ever. The outbreaks are
generally accelerated by mobility of human population, persis-
tent urbanization, and global environmental changes including
climate, land use, demographics etc. Viruses and bacteria
evolve quickly by natural selection and other mechanisms
[1]. The evolution may arise different strains to come around
through recombination and mutation. For example, H1 N1 in-
fluenza strain ("swine flu") had RNA segment from human and
bird viruses, as well as pig viruses from both North America
and Asia [2]. The devastating consequences of any outbreaks
are not only confined to mortality and morbidity of the affected
region, but also impact global economy, trade, commerce, and
traveling.
High mutation rate and rapid evolution of viruses lead to
the emergence of drug-resistant strains rather than eradication.
The discovery and development of new interventions are
usually time-consuming. Meanwhile the infection can result in
a significant loss to public health and economy. The emergent
threat posed by the epidemics can become a global public
health concern, which enhances the need for prompt detection
and characterization of outbreaks precisely [3].
Contemporary researchers have found intelligent models
as a way to predicting pandemic diseases based on diverse
factors, such as land use, human mobility information, spatial
dynamics, and overland travel data, due to the flexible and
1
scalable properties of machine learning (ML). Artificial intelli-
gence (AI) that uses ML techniques is trending towards trans-
formed provision of healthcare services to reduce economic
burden of a community or country. This revolutionary change
has high impact on improving global health. Accordingly,
public healthcare can be supported in several ways in order to
provide awareness recommendations and safety precautions to
the mass [4].
The rise of AI has already been used to slow down the
spread of disease in epidemic situation through early stage
risk prediction [5]. The example of using ML to detect weather
and land-use patterns associated with dengue fever transmis-
sion in Manila is worth mentioning [6]. Furthermore, asthma
healthcare has been aided by ML through the use of weather,
historical and pollution data [7]. In fact, the drug development
process has experienced spectacular shift from hype to hope.
AI can be regarded as a viable solution to detect pandemic
outbreaks or public health emergencies. Therefore, a modelling
framework can be applied to identify the precipitating factors
and forecast future outbreaks [8].
The major contribution of this research is to design a
high-level architecture of a universal model for early-stage
epidemic outbreak prediction and to find the necessity of
applying ML to interconnected shared data repository to
advance the public healthcare. The proposed model for future
intelligent public healthcare management aims to reduce the
morbidity, mortality, and economical burden for eliminating
the annihilation. Our evaluation based on actual COVID-19
related data demonstrates that early prediction of an outbreak
provides the necessary tools to combat epidemics and prevent
valuable lives.
The rest of the paper includes a description of our proposed
model followed by an evaluation section. Before concluding
the paper the limitations and future scopes have been pro-
vided.
II. P ROPOSED M ODEL
This section describes our proposed model for future public
health management in case of a epidemic disease outbreak like
COVID-19. The core of this model is based on the role played
by different stakeholders and data shared among all parties.
Fig. 1 shows a high-level architecture of our model, which
will be managed and controlled by AI entities, institutions,
and domain experts. In this context, we elaborate the role
of different entities, discuss the data domain, and highlight
the workflow of the system consisting of many processes
that are either computation processes or stakeholder-initiated
processes.
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B. Data Layers
This section describes shared data repository, data collec-
tion, and data integration and process layer.
1) Shared Data Repository Layer: In this layer, data con-
tributed by different entities are stored in a shared data reposi-
tory. This repository can be placed in cloud services, such as in
Azure, Amazon, and Google that enable big data analytics for
managing, processing, and storing the vast amount of hetero-
geneous data. Common data types for epidemic or pandemic
predictions are: demographic data, climate data, historical data,
etc. Besides, for treatment predictions, collective knowledge
of researchers and healthcare professionals, such as doctors,
nurses, and pharmacists will be involved.
2) Data Collection Layer: Data are obtained in both tradi-
tional and electronic manner to produce more authentic and
fast data. The traditional procedures, for example, surveys,
interviews are mostly authentic but the process is time-
consuming, whereas electronic procedures like social media
crawling and web application logs are convenient, automated,
Fig. 1: Proposed Model for Future Public Healthcare Manage- and faster. Our model suggests using both mechanisms to
ment collect data, as the sources can be different in category, size,
and specialization.
3) Data Integration and Process Layer: This layer mainly
deals with AI, ML, and data mining (DM) that can use the
A. Role of Different Entities
resources mentioned above to investigate patterns, clusters,
and predict diseases. DM and ML have a range of advanced
In this model, we consider various stakeholders and data techniques to pre-process, classify and cluster different types
providers from diverse genre. For instance, of data. The tools to use this computer-aided concept are avail-
able and enriched. AI will cover the knowledge integration and
• Government: The government acts as a major data processing and provide the means of using softbots to analyze
provider during the time of a pandemic. They can share an and forecast epidemic outbreaks.
enormous amount of valid data, for example, travel data,
flight schedules, and even private data to handle complex
situations by preserving the privacy of citizens.
• General population: This entity act as the user and the
client of healthcare services of this model. The social
media usage of this entity, chat-bot data, and their tele-
health reporting data can contribute to both data analysis
as well as automatic recommendations.
• Healthcare professionals: Real-time data can be ob-
tained from government-run hospitals, clinics, tele-
healthcare, and other heathcare service providers using
government management information system (GMIS) of a
country. Thus, healthcare professionals act as knowledge-
base data providers and can contribute to decision-making
by providing more accurate predictions of disease out-
breaks and viable precautions and treatments.
• Analysts: An analyst can be one who produces different
insights into data and detects interesting patterns of data.
For this model, we consider lab experts and data analysts,
who can support the proposed public health management
model with advanced datasets and findings.
• Industrial bodies: The industry and business can provide
healthcare and precaution supports. On the other hand,
they can also act as business insights and case report
based data providers. For example, telecom companies
can support sending bulk SMS for alerting people of a Fig. 2: Workflow of Proposed model
particular problem area.
JOURNAL OF LATEX CLASS FILES, VOL. , NO. , MONTH
C. The Workflow and the Processes
Fig. 2 illustrates the different processes that are part of the
overall architecture. The workflow starts from the descriptive
data analysis process, which are followed by forecasting,
communication, and aid stage processes. These processes are
detailed here.
1) Descriptive Data Analysis Process: In this process ML-
based data analysis will be performed. In particular, data pre-
processing, training, testing, evaluation will be conducted to
produce statistics and knowledge for further stage.
2) Forecasting Stage Processes: In this stage, risk of sea-
sonal and pandemic disease like COVID-19 are predicted.
The data of diverse sources are analyzed with AI to generate
hidden insights and patterns. Based on these data and different
variables, the disease prediction model assigns a probability
for when and where the disease event is likely to occur. Dis-
ease risk mapping or ecological niche modeling of infectious
disease recognize the pattern of species’ distribution and iden-
tify the associated specific environmental factors. It provides
the geography and ecology of disease transmission. The end-
product of the early prediction model is the location and a time
period a disease outbreak may likely occur. It can examine how
a specific disease moves through a population based on the
parameters including movement history and restrictions, which
have the effect on the severity of an epidemic. Thus, dynamics
of how a disease will spread through the population can be
explained. Early assessment of an outbreak may take place
through the collection of real-time diagnostics, clinical, or
syndromic data and the detection of spikes in signs, symptoms
or syndromes that are indicative of any disease outbreak.
3) Communication Stage Processes: The outcomes of fore-
casting stage can be used to assist local, national, and global
health policymakers. This communication step is one of the
most crucial parts as it bridges the analyzed information and
immediate action. This will be followed by taking proper
measurements by the local and global authorities responsible
for public healthcare, as well as collect feedback from different
authorities.
4) Aid Stage Processes: The final stage has a range of
significant activities like- immediate public health services,
risk management mechanisms, early-stage risk prediction,
economic loss mitigations. The policy makers will act to
support the outbreak diagnosis, treatment and risk mitigation.
Developing a novel intervention will be the next step to combat
the outbreak and to defend the rapid endless global burden.
Surveillances of the spread will allow the policymakers to
restrict movement or take proper action in order to prevent
further episodes. A coordinated response will be implemented
focusing on maintenance of situational awareness, reduction
of transmission, and treatment of the affected population.
Foreign aid providers will be prepared to deliver the surge
capacity in resource-constrained settings. Policymakers may
consider different fiscal measures to minimize the economic
loss through risk analysis, risk management plan, impact
analysis, policy management, and incident management.
3
III. E VALUATION
To evaluate the potential acceptance of the concept of
knowledge-driven early-stage prediction, we have experi-
mented and verified the predictions with real status. For the
experiment, the case of ongoing pandemic COVID-19 is con-
sidered, which has been spread over more than 200 countries
[9]. The details of the experiment are given following.
A. Data collection
The data used in our experiments are original and have been
crawled from the live corona update websites from global site
[10] and from local sites [11] [12] to provide a perspective of
COVID-19 in the context of Bangladesh. In particular, we have
collected three types of data from different sources, which are:
• Worldometer Data (WD)- This data contains informa-
tion about symptoms, gender ratio, age ratio, and pre-
existing condition for COVID-19, available on worldome-
ter [10]. For creating the knowledge base and labeling
some data, WD have been used. The attributes of this
data are tabulated in Table I.
• National healthcare call center data (NHCD)- The reg-
ular call from the mass is handled to provide healthcare
services over the phone by the national healthcare call
center of Bangladesh [12]. The data include a total of
11 types of attributes including id, calling date, phone
number, gender, division name, district name, postal
address, disease category, disease type, symptom or risk
factor and age. There are total 125,876 data instances,
which includes call data of one month (April 2020), when
the spreading of Corona virus increased exponentially in
Bangladesh. A sample of original dataset is tabulated in
Table II; some attributes like name and phone numbers
have been omitted to ensure privacy.
• Local data (LD)- The Bangladesh government is main-
taining an essential website - corona.gov.bd website [11],
with all the live status of COVID-19, including country
status and world status. Our experiment has used the
updates including affected areas, death, and confirmation
rate based on the gender and age from that dataset. This
data has been used to verify the automatic prediction from
the call center data using ML. There are 64 districts in
Bangladesh. A sample of the data has been tabulated in
Table III.
B. Data preprocessing
For all type of data mentioned above, missing value was
replaced with random sampling. The reason behind this is
the use of a mixed dataset including both the categorical
and numerical data. Therefore a check for missing value
identification was used to handle the missing values. However,
there was only 13% missing data for the attribute ’district’ in
NHCD [13].
C. Creating a knowledge base
In this experiment, we have used the shared data repository
as a knowledge base. More specifically, the knowledge base
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TABLE I: Data attributes for COVID-19 from WD

Symptom Gender Age ratio Pre-existing condition
Fever Male 80+ years Cardiovascular disease
Shortness of breath Female 70-79 years Diabetes
Muscle ache 60-69 years Chronic respiratory disease
Confusion 50-59 years Hypertension
Headache 40-49 years Cancer
Sore throat 30-39 years No pre-existing conditions
Rhinorrhoea (runny nose) 20-29 years
Chest pain 10-19 years
Diarrhoea 0-9 years
Nausea and vomiting
More than one sign or symptom
Fever, Cough, and Shortness of breath

TABLE II: Sample data of NHCD

Id calling date-time gender division district postal address symptom/risk age
726104 11:47:47 PM 30-04-2020 male Dhaka Dhaka Badda Common cold 0 Day 0 Month 30 Year
726103 11:46:38 PM 30-04-2020 female Dhaka Dhaka Jatrabari Viral fever 0 Day 10 Month 20 Year
726102 11:46:25 PM 30-04-2020 male Barisal Patuakhali Patuakhali Sadar Dry cough 0 Day 0 Month 70Year
726101 11:44:56 PM 30-04-2020 male Dhaka Dhaka Wari Dry cough 0 Day 0 Month 60 Year
726100 11:44:55 PM 30-04-2020 male Dhaka Narayanganj Rupganj Headache 0 Day 0 Month 11 Year
726099 11:44:53 PM 30-04-2020 male Dhaka Naraynaganj Rupganj Shortness of Breath 0 Day 0 Month 23 Year
726098 11:44:51 PM 30-04-2020 female Khulna Bagerhat Fever 0 Day 0 Month 32 Year
726097 11:44:26 PM 30-04-2020 male Barisal Barisal Babuganj Runny Nose 0 Day 0 Month 34 Year
726096 11:44:13 PM 30-04-2020 male Rangpur Kurigram Kurigram Sadar Diabetes 0 Day 0 Month 44 Year
726095 11:43:54 PM 30-04-2020 male Khulna Satkhira Assasuni Stroke 0 Day 0 Month 23 Year

TABLE III: Sample data of district-wise corona update from E. Classification

LD
We used scikit-learn python ML [15] to build the classifier
Confirmed Case Confirmed Death with the RF model. The classifier was trained with 80% data
District
until 30-04-2020 until 30-04-2020
Dhaka 3850 92
of the NHCD. The 80:20 percentage split was used to split the
Narayanganj 923 39 training (80%) and testing(20%) dataset. The prediction from
Gazipur 322 0 RF classification for the classes- district, symptom, gender,
Kishoreganj 200 1 and pre-existing condition are given in Table IV.
Narsingdi 145 1

TABLE IV: Prediction by RF classifier with accuracy mea- F. Evaluation and verification
sures.
To evaluate the performance of the classifier we considered
Prediction Predicted the widely accepted ML evaluation measures [13]:
Accuracy F-measure
item value i) Accuracy and F-measures in terms of true positive, true
District Dhaka 0.999 0.98
negative, false Positive, and false negative.
Gender Male 0.85 0.85
Symptom Dry-cough 0.98 0.98 ii) Precision-recall curve area (PRC area value), which
Pre-existing Cardiovascular 0.99 0.98 represents plot of Precision vs. Recall for all potential cut-
Condition offs for a test area [13].
To verify, we cross-matched the prediction with the status
of LD. From Table IV, it is evident that the prediction result
was created using WD, NHCD, and LD. The global knowledge matches the status of LD. This table contains the most signif-
of potential symptoms is provided by doctors and researchers icant prediction from NHCD dataset for COVID-19 disease.
around the world. NHCD data are from the public and autho- Again, a graph in Fig. 3, demonstrates the PRC area
rized healthcare experts. The data from LD are also verified plotting for each district, whereas the illustration Fig. 4 shows
and released data by the government. So, it can be observed weight in respective districts. Here, the weight is a simple
that different roles and data from different layers have been statistical value representing the number of confirmed COVID-
integrated to create a strong knowledge base. 19 patients in respective districts.
It is evident from Fig. 3 that by using ML classification
D. Selection algorithm technique a hidden pattern has been discovered. The plotting
Although there are several existing ML algorithms for pre- for the PRC area per district matches the statistical curve
diction, our problem and purpose require an algorithm that is of Fig. 4. Therefore, if the regular call data from NHCD
efficient for classification and regression. Besides, that specific was monitored by ML techniques like RF, more hygiene and
algorithm should be used commonly for healthcare prediction medical precautionary measurements could be undertaken by
[13]. Therefore, the ensemble decision tree technique of Ran- the infection prevention and control (IPC) focal for the risky
dom Forest (RF) was selected to train the classifier that is districts. Eventually, it could help the authorities to take action
highly scalable regardless of the number of dimensions [14]. against the significant districts before the disease outbreak.
JOURNAL OF LATEX CLASS FILES, VOL. , NO. , MONTH
Fig. 3: PRC area value for the class "District" using RF classification algorithm.
Fig. 4: Number of confirmed cases in each district from LD.
G. Discussion
Although currently most of the countries are using sta-
tistical data analysis from the live updated data, the whole
public healthcare system requires attention to consider shared
data repository and knowledge base prediction to decline
the economical and societal losses before, during, and after
an epidemic. Therefore, it is high time to use collective
knowledge and ML techniques to improve the healthcare for
the mass. Some other novel properties that can be achieved
from the proposed model are given in the following.
• Computationally Advanced: Our proposed model in
Fig. 1, is a data-driven intelligent model. As we are
proposing prevention through early-stage risk predic-
tion of pandemics and possible solutions using collec-
tive knowledge and data, computational advancement is
mandatory. To demonstrate how machine learning can
support this, we have considered a dataset of recent
pandemic outbreaks of COVID-19 in the context of
Bangladesh. From the experimental result it can be said
that a significant level of data analysis is achievable using
existing machine learning techniques.
• Smart Model: Our proposed model supports the idea
of smart model proposed in [16], which is commonly
known as smart model for change management. As our
model involves different roles, such as government, health
experts, and business experts, it will be convenient to
accept the required changes, which satisfy the unfreeze
property of the smart model. Again, as depicted in Fig. 2,
5
there is a forecast stage and an aid stage, which will
motivate the end-users to indulge themselves with a new
form of healthcare. For example, based on the geograph-
ical and weather data, seasonal flu precaution related
SMS can be propagated to the people of a region. This
follows the property of change. The shared data repository
and the collective knowledge analysis through artificial
intelligence will transform the model according to culture,
which justifies the refreeze property of the smart model.
Therefore, our proposed model can be considered as a
smart model for the upcoming data-driven smart world
of healthcare.
• Sustainable: To become sustainable, a model needs to
support business prospect and automation. Our proposed
model and its workflow demonstrate that industry experts
will be involved in this model to support healthcare
management. The upcoming industry is trending towards
Industry 4.0 [17], the key feature of which is to have a
less wasteful digital model. Therefore, this model can be
anticipated as more sustainable for the future healthcare
system.
IV. C ONCLUSION AND F UTURE S COPE
The major contribution of this paper was to introduce
an interconnected and collective knowledge-based model for
future healthcare system. The potential of the model has been
discussed from different perspectives. The proposed innovative
JOURNAL OF LATEX CLASS FILES, VOL. , NO. , MONTH 6

model can add a new dimension to public healthcare manage-

ment through initiating ML-based early prediction and preven-
tive systems. The real data analysis using ML techniques for
predicting risky areas and dynamics for the recent COVID-19
pandemic has been conducted to prove the acceptance of the
proposed shared data-oriented approach. The predicted results
obtained for the evaluation and verification matches the actual
status. Therefore, the proposed approach can be considered
as a new door to predict and control epidemic outbreaks.
In addition, a system implemented on this proposed public
healthcare management model, will provide the opportunity
to manage the hazardous conditions after a disease outbreak.

ACKNOWLEDGMENT
The authors would like to thank...

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