We were interested in novel supporting technologies for COVID-19 prevention and treatment within the past 2 years.

Articles were excluded if the results were published before 2020, were not in English, were not related to the event of COVID-19, were not related to mass testing and fast diagnosis, and when there was no access to the full texts.

The keywords “COVID-19 technology,” “COVID-19 invention,” and “COVID-19 equipment” were used in a Google search to generate related news articles and scientific reports. The initial selection was based on the titles of the news articles and scientific reports, of which 150 articles were identified in early 2021. Another 50 articles were searched via ScienceDirect. Moreover, 5 previous review papers were included [13-15].

After the initial articles were selected, they were subjected to eliminating evaluations by 2 independently working reviewers. First, each news article, as well as scientific reports, were read and manually analyzed to remove any without a technology, invention, or equipment description, which resulted in a pool of 90 articles. Then, according to the inclusion criteria, the pool was further narrowed down to 40 articles.

Next, since some news articles or scientific reports included mentions of multiple technologies, inventions, or pieces of equipment, the initial source for each technology was tracked from the news article as well as for the scientific reports.

A final yield of 23 representative articles was obtained. These 23 articles were then divided into the three categories of personal protection equipment, testing methods, and medical treatment, which were reviewed in depth. The selection of the articles followed the guideline of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020, which can be seen in Multimedia Appendix 1 [16,17].

Ethics approval has not been applied as there are no human participants involved in the study.

Overall, 9 articles were selected for this section. In general, the design and fabrication of PPE were moving toward the direction of additive manufacturing, intelligent information feedback, and eco-friendliness

Overall, 8 articles were selected for review. The articles were divided into two main categories: molecular and antigen tests [14,33,34]. The ongoing COVID-19 pandemic outbreak has posed new challenges for public health diagnostic laboratories as the infection has become widespread internationally. Rapid and scaled-up diagnostic testing is a crucial step in slowing down the pandemic as it allows more time for treating patients before symptoms manifest and reduces the risk of patients unwittingly spreading the disease [35-37]. As such, some inventions have been developed to improve the testing speed and to optimize the testing workflow.

The traditional method of testing is for trained health care workers to collect an oral or nasal swab sample and test the sample by reverse transcription-polymerase chain reaction (RT-PCR) [8]. However, this approach currently has a major limitation as the results of the swab test are received days later, with reports suggesting that the tests are taking at least four days to return. New testing methods are required to increase the volume of tests and decrease the time taken to obtain results [38]. In Table 2, several inventions for COVID-19 testing are summarized.

Cepheid’s Xpert Xpress SARS-CoV-2 test, as shown in Figure 3(a), is an automated in vitro diagnostic test for the qualitative detection of SARS-CoV-2 RNA [39]. The sample (such as a nasopharyngeal swab) is loaded into a cartridge; the cartridge is then loaded into a module; and the specimen is processed via fully automated nucleic acid extraction, amplification, amplified probe detection, and result reporting. The testing speed is rapid, enabling health care providers to obtain results within an hour of obtaining a patient sample. Once a cartridge is loaded into a module, the total time to result is about 50 minutes, with each module capable of running 28 Xpert Xpress SARS-CoV-2 tests per day. If the Xpert Xpress SAR-CoV-2 is left running, the instruments can run more than 200 patient specimens in a day [47].

Abbott’s ID NOW COVID-19 rapid test, as shown in Figure 3(c), uses RT-PCR to detect nucleic acid from SARS-CoV-2 RNA, which targets the RdRp gene [40]. It can provide positive results in 5 minutes and negative results in 13 minutes. Its small size and ability for room temperature storage enable use for testing local patients in a variety of health care environments. Patients can be tested and diagnosed on the same day as the point of care. Simple operation via visual touchscreen means it can be easily used by health care providers. Abbott is currently manufacturing 50,000 ID NOW test units per day and plans to increase its manufacturing capacity to 2 million tests per month by June 2020 [49]. However, the test is intended for testing swabs directly without elution in virus transport medium because virus transport medium samples were shown to reduce performance in low positive samples, leading to false-negative results when samples were diluted below the assay’s limit of detection [50].

In both above rapid diagnostic tests, if the virus mutates in the target region, COVID-19 may not be detected. Moreover, false-negative results may occur if a specimen is improperly collected, transported, or handled. False-negative results may also occur if there are inadequate levels of virus present in the specimen because the RT-PCR tests have a limit of detection, which is the minimum amount of viral RNA that the test will detect [51,52]. Besides improving the testing speed, optimizing the testing workflow is also helpful for increasing the testing volume and decreasing the procedure time.

Pixel by LabCorp produced a COVID-19 test, as shown in Figure 3(b), that allows for at-home sample collection. Patients can self-swab to collect their nasal samples and mail their samples in an insulated package to a LabCorp lab for testing. It allows for sample collection within the safety of the home and is beneficial because it reduces the risk of exposure to health providers and other patients to the infection [41]. It would also cut down on demand for PPE that is needed to collect specimens using the traditional testing method [53]. Test kits can be deployed on a large scale so masses of the population can be tested to help slow the spread of COVID-19. However, this self-collection kit could cause a high false-negative result if some customers perform the collection procedure incorrectly [54,55].

In the category of antigen test, the Sofia SARS Antigen FIA (fluorescent immunoassay) uses sandwich immuofluoresence-base lateral flow for the qualitative detection of SARS-CoV-2 nucleocapsid protein antigen. Based on the clinical evaluation, there was a significant reduction in turnaround time from sample collection to test results. Compared to RT-PCR, the turnaround time was reduced from 20.1 hours to 1.2 hours for Sofia SARS Antigen FIA. However, a previous study also suggested that antigen test is less suitable for both very early and late stages of SARS infection as it has lower sensitivity at high cycle threshold values [44]. The other 2 antigen tests are BD Veritor System and Abbott BinaxNOW antigen self-test [48,56].

Overall, 6 articles were selected for review. The major challenge was how to apply novel ideas to speed up the production of ventilators. Ventilators are a form of life support that takes over the work of breathing when a person is not able to breathe enough air on their own [57]. Individuals who develop COVID-19 are at risk of developing serious lung complications such as pneumonia and, in severe cases, acute respiratory distress syndrome [58,59]. In severe cases, which account for 1 in 6 people, patients require ventilatory assistance. Governments have become increasingly aware of the demand for ventilators and have started upping production [60]. For example, the United Kingdom has added another 8000 ventilators to their existing 8000, while the United States estimates it will need 60,000-160,000 additional ventilators [61,62]. Table 3 shows some major research groups or companies that are currently working on ventilators.

With the heavy demand for ventilators, researchers and companies have started to design highly scalable, innovative ideas to match these demands. MIT and Virgin Orbits have designed similar “bridge” ventilators that automate manual resuscitators, as shown in Figure 4(a) and 4(b); they aim to aid breathing for less acute patients, therefore alleviating the use of current ventilators in intensive care units [63,64]. Furthermore, a group from Glangwili Hospital is using mechanical technology to build a snood-type mask, as shown in Figure 4(c), which is connected to a filter to purify the air of coronavirus particles and to supply it to the user [65].

Materialize developed a technology to provide positive end-expiratory pressure for patients without a true ventilator. A source of oxygen was the only requirement to achieve ventilator function [66]. As shown in Figure 4(d), the design consists of a 3D-printed connector that connects a positive end-expiratory pressure valve, a mask, and a filter. A multidisciplinary team of engineers and medics at the University of Oxford and King’s College London have developed a new ventilator called OxVent, as shown in Figure 4(c), which is made from off-the-shelf components and equipment with certain elements that can be produced through 3D-printing techniques [67]. The OxVent is portable and inflates the patients’ chest by injecting compressed air. Another solution to respond to the shortage of ventilators was developed in several hospitals, where they shared the same ventilator between 2 patients with some normal tubes instead of building a new ventilator, as seen in Figure 4(f) [68]. An operation protocol for ventilator sharing has been developed by engineers and medics as a response to this innovation to ensure safety [69].

The shortage of medical equipment, such as masks and ventilators, has been the biggest challenge. Although insufficient stockpiling of medical equipment is one of the reasons attributed to the shortage, the most important reason is the high labor dependency of the medical equipment industry. The shortage of labor and the high infection risk in a crowded working environment have limited the capacity of the medical equipment industry. Approaches should be considered for the medical equipment industry for future responses. It is time to optimize the current processing flow and improve the degree of automation so that the dependence on labor can be reduced. Many cases have been reported on the use of 3D printers for producing medical equipment on a small scale, such as masks, ventilator parts, and quarantine rooms. Although 3D-printing technology could significantly reduce the amount of labor required for production, cost and efficiency are still challenges at this stage. Other critical labor-intensive industries, such as the food processing industry and delivery industry, have also been reported as imposing high risks of large-scale infection [70-72]. Labor shortages in these industries have led to shortages of basic human necessities. For such industries, improving the degree of automation and reducing the degree of labor dependence are also necessary measures to ensure better responses to future pandemics.

On the other hand, the shortage of lifesaving machines such as ventilators during the pandemic could illustrate a point: medical technology research, supported by taxpayer money, may not be sufficient for handling global outbreaks such as COVID-19. Traditional funding mechanisms have singularly focused on supporting “high-risk, high-reward” research activities to support creative scientists pursuing highly innovative research rather than low-cost and scalable technologies that could address the public health demands during the pandemic. Technologies developed to address the COVID-19 pandemic should meet epidemiological needs and help manage outbreaks. They need to be low-cost scalable solutions that are practical for patients and health care workers as well as being widely accessible to the global community. However, publicly funded medical research has long been skewed toward ideas proposed by research-intensive, highly developed, and resource-abundant researchers.

The paper only investigated the small to medium size supporting medical equipment for COVID-19. Large equipment such as computed tomography or magnetic resonance imaging scanners have not been included in this study. Moreover, the paper only provides a qualitative comparison between the technologies. The search strategy was not comprehensive as it was limited to two databases: Google and ScienceDirect. Even though some of the complexities were unveiled regarding supporting technologies, a quantitative analysis would have also added value to the review results. Moreover, the protocol that was not registered with PROSPERO (international prospective register of systematic reviews) might have affected the results in one way or the other. There was no formal appraisal of the included studies as well as the overall evidence from included studies.

The study objectives were to evaluate existing support technologies for COVID-19 prevention, diagnosis, and treatment. A total of 18 technologies in the areas of PPE, testing methods, and medical treatment were selected for review. The engineering characteristics of each invention were summarized, and the potential to make a significant impact on the pandemic response was evaluated and discussed. One major hurdle to adopting the technologies discussed in this paper or any other prospective technologies was that COVID-19–related research is still in the early stages, so even if innovations look promising, their safety and efficiency have not yet been tested and evaluated in a rigorous scientific manner.

The unexpectedly large and widespread impact of the COVID-19 pandemic has led to many challenges in the management of the disease for both public health agencies and hospitals. Shortages of essential medical resources, including SARS-CoV-2 testing kits, ventilators, and personal protective equipment, have been the biggest challenge throughout the world. In this review paper, technologies developed during the COVID-19 pandemic in response to clinical and public health needs were considered for review. In order to better respond to pandemics in the future, several directions have been discussed. For example, national reserves of critical medical supplies should be increased to improve preparation. Regarding the manufacturing of medical equipment, this pandemic has highlighted the need for the automation degree of medical manufacturing to be increased and for production workflows to be optimized. Finally, a shift in the approach to funding scientific research should be implemented during pandemics to promote low-cost, scalable solutions.