CO-Away: Implementation and Evaluation of Digital Health Solutions for Indigenous Self-Determination, Governance, and Data Sovereignty

During wave 1 of the COVID-19 pandemic, northern Indigenous communities in Saskatchewan experienced a rapid surge of COVID-19 cases, with the highest number of active cases in the province at a time when the rest of Saskatchewan was showing signs of recovery. This is an indication that the timeline of outbreak waves in remote Indigenous communities differs from larger population centres. More distressingly, while the rate of infections in remote Indigenous communities was projected to rise sharply, other parts of the country were already planning to reduce restrictions - reiterating the history of disjointed and bifurcated policy towards Indigenous Peoples. The 1918 influenza pandemic swept across the frozen lakes and boreal forests to devastate communities in the north. 100 years later, the risk to remote Indigenous communities is still high, especially because inadequate housing and overcrowding increase COVID-19 transmission. To address this risk, we have developed CO-Away, a culturally-responsive digital epidemiological platform to monitor, mitigate, and manage Coronavirus disease (COVID-19) outbreaks. CO-Away's purpose is to serve Indigenous communities and enable Indigenous self-governance, determination, and data sovereignty. CO-Away will be launched in Ile-a-la-Crosse, a subarctic northern community in Saskatchewan. The CO-Away platform consists of two key components - a frontend virtual care smartphone application (app), and a backend digital decision-making dashboard. The app provides three key precision medicine services that are specific to each citizen: 1) continuous risk assessment of contracting COVID-19 via the virtual doctor feature; 2) evidence-based public health communication; and 3) Citizen reporting of food availability, access to public services, and COVID-19 symptoms and test results - these culturally-responsive features have been co-created with Ile-a-la-Crosse Metis decision-makers based on imminent community needs and preferences.