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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Med.</journal-id>
<journal-title>Frontiers in Medicine</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Med.</abbrev-journal-title>
<issn pub-type="epub">2296-858X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fmed.2022.871885</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Medicine</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Automated artificial intelligence-enabled proactive preparedness real-time system for accurate prediction of COVID-19 infections&#x2014; Performance evaluation</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name><surname>Ismail</surname> <given-names>Leila</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1668649/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Materwala</surname> <given-names>Huned</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Al Hammadi</surname> <given-names>Yousef</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Firouzi</surname> <given-names>Farshad</given-names></name>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Khan</surname> <given-names>Gulfaraz</given-names></name>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/631516/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Azzuhri</surname> <given-names>Saaidal Razalli Bin</given-names></name>
<xref ref-type="aff" rid="aff7"><sup>7</sup></xref>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Intelligent Distributed Computing and Systems (INDUCE) Laboratory, College of Information Technology, United Arab Emirates University</institution>, <addr-line>Al Ain</addr-line>, <country>United Arab Emirates</country></aff>
<aff id="aff2"><sup>2</sup><institution>Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University</institution>, <addr-line>Al Ain</addr-line>, <country>United Arab Emirates</country></aff>
<aff id="aff3"><sup>3</sup><institution>National Water and Energy Center, United Arab Emirates University</institution>, <addr-line>Al Ain</addr-line>, <country>United Arab Emirates</country></aff>
<aff id="aff4"><sup>4</sup><institution>Department of Information System and Security, College of Information Technology, United Arab Emirates University</institution>, <addr-line>Al Ain</addr-line>, <country>United Arab Emirates</country></aff>
<aff id="aff5"><sup>5</sup><institution>Department of Electrical and Computer Engineering, Duke University</institution>, <addr-line>Durham, NC</addr-line>, <country>United States</country></aff>
<aff id="aff6"><sup>6</sup><institution>Department Medical Microbiology and Immunology, College of Medicine and Health Sciences, Tawam Hospital</institution>, <addr-line>Al Ain</addr-line>, <country>United Arab Emirates</country></aff>
<aff id="aff7"><sup>7</sup><institution>Department of Computer System and Technology, Faculty of Computer Science and Information Technology, University of Malaya</institution>, <addr-line>Kuala Lumpur</addr-line>, <country>Malaysia</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Bin Luo, Lanzhou University, China</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Aurel Pera, University of Craiova, Romania; Mingke Wang, Naval Medical Center, China; Seetha Harilal, Kerala University of Health Sciences, India; Zengliang Ruan, Southeast University, China</p></fn>
<corresp id="c001">&#x002A;Correspondence: Leila Ismail, <email>leila@uaeu.ac.ae</email></corresp>
<fn fn-type="other" id="fn004"><p>This article was submitted to Infectious Diseases &#x2013; Surveillance, Prevention and Treatment, a section of the journal Frontiers in Medicine</p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>30</day>
<month>08</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>9</volume>
<elocation-id>871885</elocation-id>
<history>
<date date-type="received">
<day>08</day>
<month>02</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>01</day>
<month>08</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2022 Ismail, Materwala, Al Hammadi, Firouzi, Khan and Azzuhri.</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Ismail, Materwala, Al Hammadi, Firouzi, Khan and Azzuhri</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<abstract>
<p>COVID-19 is a contagious disease that has infected over half a billion people worldwide. Due to the rapid spread of the virus, countries are facing challenges to cope with the infection growth. In particular, healthcare organizations face difficulties efficiently provisioning medical staff, equipment, hospital beds, and quarantine centers. Machine and deep learning models have been used to predict infections, but the selection of the model is challenging for a data analyst. This paper proposes an automated Artificial Intelligence-enabled proactive preparedness real-time system that selects a learning model based on the temporal distribution of the evolution of infection. The proposed system integrates a novel methodology in determining the suitable learning model, producing an accurate forecasting algorithm with no human intervention. Numerical experiments and comparative analysis were carried out between our proposed and state-of-the-art approaches. The results show that the proposed system predicts infections with 72.1% less Mean Absolute Percentage Error (MAPE) and 65.2% lower Root Mean Square Error (RMSE) on average than state-of-the-art approaches.</p>
</abstract>
<kwd-group>
<kwd>automated artificial intelligence (Auto-AI)</kwd>
<kwd>coronavirus</kwd>
<kwd>COVID-19 infection prediction</kwd>
<kwd>deep learning</kwd>
<kwd>healthcare</kwd>
<kwd>machine learning</kwd>
<kwd>performance evaluation</kwd>
<kwd>time series</kwd>
</kwd-group>
<counts>
<fig-count count="9"/>
<table-count count="6"/>
<equation-count count="2"/>
<ref-count count="47"/>
<page-count count="17"/>
<word-count count="9716"/>
</counts>
</article-meta>
</front>
<body>
<sec id="S1" sec-type="intro">
<title>Introduction</title>
<p>More than 2 years after the outbreak of the COVID-19 disease, the containment of this virus still represents a serious challenge to the world community.<sup><xref ref-type="fn" rid="footnote1">1</xref></sup> Over half a billion people have been infected worldwide, including more than 6.27 million deaths as of 20 May 2022.<sup><xref ref-type="fn" rid="footnote2">2</xref></sup> Studies have revealed that COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), not only affects the lungs of the infected person but also negatively impacts other vital organs such as the brain, heart, liver, pancreas, and kidney (<xref ref-type="bibr" rid="B1">1</xref>&#x2013;<xref ref-type="bibr" rid="B3">3</xref>). Effect on the brain can lead to muscular pain and headaches in individuals with a mild infection, whereas in severe cases it could lead to stroke (<xref ref-type="bibr" rid="B2">2</xref>). Heart complications due to SARS-CoV-2 include inflammation and dysfunction of muscles and may cause the death of patients suffering from cardiovascular diseases (<xref ref-type="bibr" rid="B2">2</xref>). Furthermore, the SARS-CoV-2 virus could lead to pancreatic islet-cell dysfunction (<xref ref-type="bibr" rid="B3">3</xref>) causing diabetes (<xref ref-type="bibr" rid="B4">4</xref>&#x2013;<xref ref-type="bibr" rid="B6">6</xref>). In addition, it causes liver impairment and acute kidney injury (<xref ref-type="bibr" rid="B2">2</xref>). To reduce the spread of the virus, countries have imposed several strict policies and practices, such as travel bans, home confinement, and business closures. These measures showed to be effective in reducing the infection and death rates during this pandemic (<xref ref-type="bibr" rid="B7">7</xref>&#x2013;<xref ref-type="bibr" rid="B9">9</xref>). However, too strict measures may lead to income loss, anxiety, and depression on an individual scale, and cause longer-term economic and social hardship on the national scale (<xref ref-type="bibr" rid="B10">10</xref>&#x2013;<xref ref-type="bibr" rid="B12">12</xref>). A survey conducted in the United States of America among 5,412 adults showed that 31% of the respondents suffered from anxiety/depression symptoms, 26% from stressor-related disorder symptoms, and 11% considered suicide during the COVID-19 pandemic (<xref ref-type="bibr" rid="B13">13</xref>). Strict confinement measures have also shown an adverse effect on students&#x2019; mental health. A survey conducted on 69,054 university students during the lockdown in France revealed that 27.5 and 24.7% of the respondents had a high level of anxiety and stress, respectively, 16.1% had severe depression, and 11.4% had suicidal thoughts (<xref ref-type="bibr" rid="B14">14</xref>). In addition, individuals often miss routine medical checkups and tests due to confinement, leading to severe health issues, especially in patients suffering from chronic diseases (<xref ref-type="bibr" rid="B15">15</xref>). Discontinued daily exercises have been leading to obesity and associated health risks (<xref ref-type="bibr" rid="B16">16</xref>). Consequently, it becomes crucial to predict infections to gain a better understanding of the growth of the infection curve, and deeper insight into when to enact, relax or terminate these strategies. In addition, infection forecasting allows healthcare organizations to effectively plan the required medical resources enabling smart healthcare (<xref ref-type="bibr" rid="B17">17</xref>, <xref ref-type="bibr" rid="B18">18</xref>).</p>
<p>Artificial Intelligence (AI) algorithms have been widely adopted in the medical sector to enable smarter, effective, and efficient healthcare (<xref ref-type="bibr" rid="B19">19</xref>). Different AI-based algorithms are used for screening, diagnosing, and monitoring COVID-19 (<xref ref-type="bibr" rid="B20">20</xref>&#x2013;<xref ref-type="bibr" rid="B22">22</xref>) as well as for predicting the number of infections (<xref ref-type="bibr" rid="B23">23</xref>&#x2013;<xref ref-type="bibr" rid="B29">29</xref>). Recent studies have used machine/deep learning time series models to predict the spread of COVID-19 infections, based on previous infections, in a few countries. These studies use different prediction models (<xref ref-type="bibr" rid="B30">30</xref>). However, considering the difference in the geographical characteristics and social behaviors of the countries under study, we argue that the use of a single prediction model becomes questionable (<xref ref-type="bibr" rid="B31">31</xref>). This is because the model is not capable to capture the infection evolution, leading to inaccurate prediction. Such a failure may lead to greater distress and more deaths. Furthermore, these models need to be constantly updated and fail to capture the evolving COVID-19 variants such as omicron.</p>
<p>To address these shortcomings, in this paper, we propose an automated AI-enabled proactive preparedness system for accurate prediction of COVID-19 infection growth in real-time, with no human intervention. The proposed system incorporates an intelligent agent that analyses the temporal distribution of the infection evolution for a city/state/country and maps the prediction model to the corresponding trend using a novel trend-to-model mapping approach. The prediction results by the system aid government and healthcare organizations to be well prepared and proactively tackle the chaotic pandemic situation. For instance, the measures can be relaxed if the prediction shows a decrease in COVID-19 infections, whereas they can be made stricter if an increase in the number of infections is predicted. A detailed real-time infection data acquisition, preprocessing framework, and request-response flow are presented. The performance of the proposed system is compared with state-of-the-art approaches to predict COVID-19 infections in fifteen countries based on the literature.</p>
</sec>
<sec id="S2">
<title>Related work</title>
<p>Time series prediction is a useful method that considers the influence of previous infection data to predict future data (<xref ref-type="bibr" rid="B31">31</xref>). Different machine learning algorithms have been used to analyze the data of epidemic and pandemic diseases such as influenzas A (H1N1),<sup><xref ref-type="fn" rid="footnote3">3</xref></sup> B,<sup><xref ref-type="fn" rid="footnote4">4</xref></sup> measles childhood disease (<xref ref-type="bibr" rid="B32">32</xref>), SARS, MERS, and COVID-19 outbreaks, at the country, regional or global level (<xref ref-type="bibr" rid="B31">31</xref>). Though any machine learning algorithm can produce reliable results at some level, time series algorithms are the most accurate approaches to studying epidemic and pandemic diseases because of their dynamic and temporal nature (<xref ref-type="bibr" rid="B33">33</xref>). Several studies in the literature have proposed the use of different time series machine learning and deep learning algorithms for the prediction of COVID-19 infections in different countries (<xref ref-type="bibr" rid="B23">23</xref>&#x2013;<xref ref-type="bibr" rid="B29">29</xref>).</p>
<p>As shown in <xref ref-type="table" rid="T1">Table 1</xref>, the selection of machine learning algorithms is either not justified (<xref ref-type="bibr" rid="B23">23</xref>&#x2013;<xref ref-type="bibr" rid="B26">26</xref>), or based on the popularity of the prediction algorithm (<xref ref-type="bibr" rid="B27">27</xref>, <xref ref-type="bibr" rid="B28">28</xref>), or the performance of the algorithm when implemented for some other country (<xref ref-type="bibr" rid="B29">29</xref>). However, given the significant difference in the geographical characteristics and social behaviors of the countries, the use of a single algorithm to predict disease spread becomes questionable, as it is highly likely that the algorithm fails to generate accurate predictions (<xref ref-type="bibr" rid="B31">31</xref>). Consequently, an algorithm should be selected based on the temporal distribution of the infection evolution data for a country. In this paper, we propose an intelligent agent, integrated within an automated AI system, that will analyze the trend of infection growth in a country, and selects the most accurate learning algorithm. This algorithm predicts COVID-19 infections with the least error for that country than other state-of-the-art algorithms. We compare the performance of our selected algorithm for each country in <xref ref-type="table" rid="T1">Table 1</xref> with the outperforming algorithm(s) for that country in the literature.</p>
<table-wrap position="float" id="T1">
<label>TABLE 1</label>
<caption><p>Summary of COVID-19 infection prediction using time series machine learning and deep learning algorithms.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left">Work</td>
<td valign="top" align="center">Considered countries</td>
<td valign="top" align="center">Considered algorithms</td>
<td valign="top" align="center">Justification for algorithm selection</td>
<td valign="top" align="center">Considered period for developing the algorithm</td>
<td valign="top" align="center">Considered period for validating the algorithm</td>
<td valign="top" align="center">Outperforming algorithm</td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Ahmar and Del Val (<xref ref-type="bibr" rid="B23">23</xref>)</td>
<td valign="top" align="center">Spain</td>
<td valign="top" align="center">ARIMA and SutteARIMA</td>
<td valign="top" align="center">NR</td>
<td valign="top" align="center">02/12&#x2013;04/02 2020</td>
<td valign="top" align="center">04/03&#x2013;04/09 2020</td>
<td valign="top" align="center">SutteARIMA</td>
</tr>
<tr>
<td valign="top" align="left">Gecili et al. (<xref ref-type="bibr" rid="B24">24</xref>)</td>
<td valign="top" align="center">United States and Italy</td>
<td valign="top" align="center">HLT, ARIMA, TBATS, and cubic smoothing spline</td>
<td valign="top" align="left"/><td valign="top" align="center">02/22&#x2013;04/29 2020</td>
<td valign="top" align="center">02/22&#x2013;04/29 2020</td>
<td valign="top" align="center">ARIMA</td>
</tr>
<tr>
<td valign="top" align="left">Shahid et al. (<xref ref-type="bibr" rid="B25">25</xref>)</td>
<td valign="top" align="center">Brazil, Germany, Italy, Spain, United Kingdom, China, India, Israel, Russia, and United States</td>
<td valign="top" align="center">ARIMA, SVR, LSTM, Bi-LSTM, GRU</td>
<td valign="top" align="left"/><td valign="top" align="center">01/22&#x2013;05/10 2020</td>
<td valign="top" align="center">05/11&#x2013;06/27 2020</td>
<td valign="top" align="center">Bi-LSTM</td>
</tr>
<tr>
<td valign="top" align="left">Ayoobi et al. (<xref ref-type="bibr" rid="B26">26</xref>)</td>
<td valign="top" align="center">Australia and Iran</td>
<td valign="top" align="center">LSTM, Bi-LSTM, Convolutional LSTM, Bi-Convolutional LSTM, GRU, Bi-GRU</td>
<td valign="top" align="left"/><td valign="top" align="center">(Australia)<break/> 01/25&#x2013;05/20 2020<break/> (Iran)<break/> 01/03&#x2013;06/06 2020</td>
<td valign="top" align="center">(Australia)<break/> 05/21&#x2013;06/18 2020 (validation)<break/> 06/19&#x2013;08/19 2020 (testing)<break/> (Iran)<break/> 06/07&#x2013;07/15 2020<break/> (validation)<break/> 07/16&#x2013;10/06 2020 (testing)</td>
<td valign="top" align="center">LSTM (Australia)<break/> Bi-GRU (Iran)</td>
</tr>
<tr>
<td valign="top" align="left">Ceylan (<xref ref-type="bibr" rid="B27">27</xref>)</td>
<td valign="top" align="center">Italy, Spain, and France</td>
<td valign="top" align="center">ARIMA</td>
<td valign="top" align="center">Widely used in literature</td>
<td valign="top" align="center">02/21&#x2013;04/15 2020</td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">ARIMA</td>
</tr>
<tr>
<td valign="top" align="left">Singh et al. (<xref ref-type="bibr" rid="B28">28</xref>)</td>
<td valign="top" align="center">Malaysia</td>
<td valign="top" align="center">ARIMA</td>
<td valign="top" align="left"/><td valign="top" align="center">01/22&#x2013;03/31 2020</td>
<td valign="top" align="center">04/01&#x2013;04/17 2020</td>
<td valign="top" align="center">ARIMA</td>
</tr>
<tr>
<td valign="top" align="left">Alzahrani et al. (<xref ref-type="bibr" rid="B29">29</xref>)</td>
<td valign="top" align="center">Saudi Arabia</td>
<td valign="top" align="center">AR, MA, ARMA, ARIMA</td>
<td valign="top" align="center">Accurate for other countries</td>
<td valign="top" align="center">03/02&#x2013;04/20 2020</td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">ARIMA</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn><p>AR, AutoRegressive; ARIMA, AutoRegressive Integrated Moving Average; ARMA, AutoRegressive Moving Average; Bi-LSTM, Bidirectional Long Short-Term Memory; GRU, Gated Recurrent Unit; HLT, Holt&#x2019;s Linear Trend; LSTM, Long Short-Term Memory; MA, Moving Average; NR, Not Reported; NA, Not Applicable; SVR, Support Vector Regression; TBATS, Trigonometric Exponential smoothing state-space model with Box-Cox transformation.</p></fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="S3" sec-type="materials|methods">
<title>Materials and methods</title>
<sec id="S3.SS1">
<title>Automated artificial intelligence-enabled proactive preparedness real-time system for accurate COVID-19 infection prediction</title>
<p>This section presents the workflow of our proposed system for predicting COVID-19 infections along with the steps involved. It explains the method used to select the most accurate model for prediction based on the infection&#x2019;s trend. The use of a systematic workflow for the problem of infection prediction is the most important for the accurate infection prediction for a given country. <xref ref-type="fig" rid="F1">Figure 1A</xref> shows the seven stages involved in the proposed system. In the following, we explain each stage in detail.</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption><p><bold>(A)</bold> Workflow of the proposed automated artificial intelligence-enabled system for infection prediction, <bold>(B)</bold> architecture of long short-term memory (LSTM) cell and Bidirectional-LSTM network used in the proposed system for infection prediction, and <bold>(C)</bold> request-response workflow in the proposed system.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmed-09-871885-g001.tif"/>
</fig>
<sec id="S3.SS1.SSS1">
<title>Infection data collection</title>
<p>The city-level, state-level, and/or country-level infection data can be collected from a data source that can be either an online repository (such as Johns Hopkins), healthcare organizations, and/or specialized national/international agencies for public health such as World Health Organization (WHO). In this study, we used the Johns Hopkins dataset which includes COVID-19 infections, recoveries, and deaths data from different provinces/states and countries/regions since 22 January 2020. The data fetcher module in our framework sends an HTTP request to a data source for accessing the infection data. A request contains information regarding the city/state/country and the period for which the data is required. In response to the request, the source sends the queried infection data to the fetcher module. The data is fetched at a periodic interval, which can be seconds, minutes, hours, or days depending on the frequency the data is updated in the data source and is stored in a cloud database (<xref ref-type="bibr" rid="B34">34</xref>&#x2013;<xref ref-type="bibr" rid="B38">38</xref>).</p>
</sec>
<sec id="S3.SS1.SSS2">
<title>Data preprocessing</title>
<p>The retrieved infection data is preprocessed to make it ready for the machine/deep learning algorithm. This is done by removing irrelevant attributes. As our system predicts the number of infections, the deaths and recoveries data are removed. In addition, preprocessing involves the identification and removal of outliers if any, as well as the identification and handling of missing values. The identification of outliers in infection prediction is important as the learning algorithms are sensitive to outliers and could produce unexpected results (<xref ref-type="bibr" rid="B39">39</xref>). The outliers, if present, can be removed using visualization of the infection data plot and/or machine learning approaches based on bagging, boosting, and local outlier factor algorithm (<xref ref-type="bibr" rid="B39">39</xref>). The missing values in infection data, if any, can be handled either by removing the corresponding timestamp from the dataset or adding synthetic values. The synthetic values can be generated using statistical methods such as mean, median, and mode, or machine learning approaches such as kNN imputation and rpart (<xref ref-type="bibr" rid="B39">39</xref>).</p>
</sec>
<sec id="S3.SS1.SSS3">
<title>Infection trend-to-model mapping</title>
<p>The trend of the preprocessed infection data is analyzed to select the most accurate prediction model that is adaptive to the dynamicity of the evolution of the infection spread. The most accurate model predicts the infections with the least error compared to other models. To analyze the distribution of the infection spread, the infection data is first divided into intervals of equal length as shown in <xref ref-type="fig" rid="F1">Figure 1A</xref>. The slope between each interval is then determined by constructing a linear model between the interval endpoints. If all the data points between the interval endpoints lie below the data points on the linear model, then the slope between the interval endpoints is convex. On the other hand, if all the points between the interval endpoints lie above the points on the linear model, then the slope between the endpoints is concave. The slope is straight if the data points between the interval points lie on the constructed linear model. The distribution of the infection&#x2019;s trend is then determined based on the slopes, and a corresponding prediction model is selected. ARIMA model is selected to model the infection data following an exponential trend with a constant rate. This is because ARIMA is best suited to capture the exponential behavior of the infection growth (<xref ref-type="bibr" rid="B31">31</xref>). For the infection&#x2019;s data having an exponential trend with varying rates, the Long Short-Term Memory (LSTM) and Bidirectional-LSTM (Bi-LSTM) models are selected as it is capable of capturing the variability in the data (<xref ref-type="bibr" rid="B31">31</xref>). The infection data that increase linearly over time are modeled using the Linear Trend (LT) model. For data evolving in a polynomial fashion, the Quadratic Trend (QT) model is selected. HLT model is selected for exponential + linear infection trend. This is because the HLT model is a linear function of trend and slope that captures well the linearity in an exponential trend over time. For the infection&#x2019;s data with an exponential + damping trend, Damped Trend (DT) model is selected as the damping parameter used by the model provides an accurate prediction of infections for a trend that dampens over time. <xref ref-type="fig" rid="F1">Figure 1B</xref> represents the architectures for the LSTM cell and Bi-LSTM network. The main components of LSTM are the cell state and gates. The cell state transfers the significant previous infection data to the chain of LSTM cells. Gates in LSTM are responsible for storing relevant and removing irrelevant infection data. LSTM consists of three gates: forget, input, and output. All the gates have a sigmoid activation function except the input gate which utilizes a hyperbolic tangent activation function. In LSTM, the forget gate is responsible for removing irrelevant infection data based on the prediction output of the previous cell. The input gate adds the new infection data to the memory cell state. Finally, the output gate generates the output of the cell, i.e., the predicted infections for the next time step based on the current infections and cell state. Bi-LSTM is a recurrent neural network that consists of two LSTM networks, one in the forward direction and another in the backward.</p>
</sec>
<sec id="S3.SS1.SSS4">
<title>Model calibration</title>
<p>The selected prediction model is calibrated for hyperparameter tuning. It is an important stage as non-optimal parameters&#x2019; values may increase the resource utilization and execution time for model development and can degrade the model&#x2019;s convergence and prediction performance.</p>
</sec>
<sec id="S3.SS1.SSS5">
<title>Model development</title>
<p>The dataset is split into training and validation. The most common approach is splitting the dataset into 70 and 30% for training and validation, respectively. The selected algorithm, with the optimal values of the parameters, is then developed using the training dataset.</p>
</sec>
<sec id="S3.SS1.SSS6">
<title>Model validation</title>
<p>The developed model is validated using the validation dataset in terms of Mean Absolute Percentage Error (MAPE) and Root Mean Squared Error (RMSE).</p>
</sec>
<sec id="S3.SS1.SSS7">
<title>Model implementation</title>
<p>The model is implemented in real-time for predicting infections for a city, state, and/or country. The infections trend-to-model mapping, model calibration, and model development are iterative stages. These stages are repeated based on updated and/or new data.</p>
<p><xref ref-type="fig" rid="F1">Figure 1C</xref> shows the request-response workflow used in the proposed system. The healthcare organizations and the government users interact with the front-end interface of the system. They are authorized based on their Access Control List (ACL) or Role-Based Access Control (RBAC) which is defined by policy. The Certificate Authority (CA) (<xref ref-type="bibr" rid="B40">40</xref>&#x2013;<xref ref-type="bibr" rid="B42">42</xref>) generates a pair of public-private keys (<xref ref-type="bibr" rid="B43">43</xref>) for all the users. We suggest to use asymmetric cryptosystem such as Elliptic Curve Cryptography (ECC) (<xref ref-type="bibr" rid="B44">44</xref>) with the key length of at least 384 bit,<sup><xref ref-type="fn" rid="footnote5">5</xref></sup> which is equivalent to 7,680 bit RSA (<xref ref-type="bibr" rid="B45">45</xref>), for exchanging the key and then 256 bit key of Advanced Encryption Standard (AES), recommended by National Security Agency (NSA), for encryption and decryption ensuring secure communication. In addition, to ensure the integrity of data received from an external source, the SHA3-256 algorithm is used which guarantees that the data has not been modified.</p>
<p>The front-end runs on the user&#x2019;s premises and communicates with the back-end that consists of our proposed intelligent agent. The prediction request from a user, i.e., the country for which the prediction is required, the prediction period, and the certificate, are sent to the encryptor. The encryptor encrypts the prediction request using the user&#x2019;s private key. The encrypted request is sent to the intelligent agent in the back-end. The agent decrypts the request using the public key of the request initiator. Once successfully decrypted, the agent analyzes the trend of the infection data for the country and selects the most accurate prediction model. The results of the prediction model are then encrypted by the agent using the initiator&#x2019;s public key. The encrypted prediction response is sent to the user at the front-end. The response is then decrypted using the user&#x2019;s private key.</p>
</sec>
</sec>
<sec id="S3.SS2">
<title>Implementation of the proposed automated artificial intelligence-enabled system for real-time infection prediction</title>
<p>In this section, the implementation of the real-time system is discussed. The suggested implemented diagram is shown in <xref ref-type="fig" rid="F2">Figure 2</xref>. The infection data is collected from different data sources <italic>D</italic><sub><italic>src</italic></sub> such as the Ministry of Health, Hospitals, and public health agencies (for example WHO). The infection data <italic>Inf</italic> is stored using the data storage component. The raw infection data is stored as a data frame <italic>df</italic><sub><italic>inf</italic></sub>is fed as an input to the data transformation component. The preprocessed data frame <inline-formula><mml:math id="INEQ2"><mml:mrow><mml:mi>d</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mmultiscripts><mml:mi>f</mml:mi><mml:none/><mml:mo>&#x2032;</mml:mo><mml:mrow><mml:mi>i</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>n</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>f</mml:mi></mml:mrow><mml:none/></mml:mmultiscripts></mml:mrow></mml:math></inline-formula> is again stored. The transformed data is constantly updated in the storage in real-time using a data update feedback loop. The preprocessed data is then divided into training <inline-formula><mml:math id="INEQ3"><mml:mrow><mml:mi>d</mml:mi><mml:mo>&#x2062;</mml:mo><mml:msubsup><mml:mi>f</mml:mi><mml:mrow><mml:mi>i</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>n</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>f</mml:mi></mml:mrow><mml:mrow><mml:mi>t</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>r</mml:mi></mml:mrow></mml:msubsup></mml:mrow></mml:math></inline-formula> and validation <inline-formula><mml:math id="INEQ4"><mml:mrow><mml:mi>d</mml:mi><mml:mo>&#x2062;</mml:mo><mml:msubsup><mml:mi>f</mml:mi><mml:mrow><mml:mi>i</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>n</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>f</mml:mi></mml:mrow><mml:mrow><mml:mi>v</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>d</mml:mi></mml:mrow></mml:msubsup></mml:mrow></mml:math></inline-formula> datasets. A model is selected by the intelligent agent based on the temporal distribution of the infection data evolution. The selected model <italic>f</italic>(<italic>inf</italic>)is developed using<inline-formula><mml:math id="INEQ6"><mml:mrow><mml:mpadded lspace="5pt" width="+5pt"><mml:mi>d</mml:mi></mml:mpadded><mml:mo>&#x2062;</mml:mo><mml:msubsup><mml:mi>f</mml:mi><mml:mrow><mml:mi>i</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>n</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>f</mml:mi></mml:mrow><mml:mrow><mml:mi>t</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>r</mml:mi></mml:mrow></mml:msubsup></mml:mrow></mml:math></inline-formula>. The performance of the model is evaluated using<inline-formula><mml:math id="INEQ7"><mml:mrow><mml:mpadded lspace="5pt" width="+5pt"><mml:mi>d</mml:mi></mml:mpadded><mml:mo>&#x2062;</mml:mo><mml:msubsup><mml:mi>f</mml:mi><mml:mrow><mml:mi>i</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>n</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>f</mml:mi></mml:mrow><mml:mrow><mml:mi>v</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>d</mml:mi></mml:mrow></mml:msubsup></mml:mrow></mml:math></inline-formula>. The model development is a feedback control process where the model is tuned using hyperparameter tuning unless the desired performance is obtained. The infection prediction error <italic>e</italic><sub><italic>inf</italic></sub>obtained from the evaluation is fed back to tune the hyperparameters. The tuned model <italic>f</italic>&#x002A;(<italic>inf</italic>) is deployed for predicting infections accurately. The deployed model is updated in real-time using the model feedback loop when the infection data is updated. The healthcare organizations and the government then use the deployed model to predict the infections. This is by providing the input arguments, country for which the prediction is required, and the duration of prediction <italic>C</italic>, <italic>t</italic>. The number of infections for the prediction period <italic>Inf<sub>t</sub></italic> is sent to the healthcare organizations and the government.</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption><p>Implementation of the proposed real-time prediction system.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmed-09-871885-g002.tif"/>
</fig>
</sec>
<sec id="S3.SS3">
<title>Dataset</title>
<p>To evaluate the performance of our proposed system, we developed the prediction models for fifteen countries based on the literature (<xref ref-type="table" rid="T1">Table 1</xref>). We used the Johns Hopkins COVID-19 dataset that is updated daily.<sup><xref ref-type="fn" rid="footnote6">6</xref></sup> <xref ref-type="table" rid="T2">Table 2</xref> presents the countries for which the prediction models are developed, the features of the dataset, data update frequency, and the period for which the COVID-19 infections data are extracted for the countries under study. The dataset has no outliers and missing values. We used the number of confirmed cases for each country to develop the models. <xref ref-type="fig" rid="F3">Figure 3</xref> shows the infection trend for the considered countries. As shown in the figure, the distribution of the infection growth for each country is different. In this paper, we use country-level data for the evaluation as the dataset does not include city-level or state-level data for the countries under study. However, the system can be used for city-level or state-level infection data as well.</p>
<table-wrap position="float" id="T2">
<label>TABLE 2</label>
<caption><p>Characteristics of the COVID-19 dataset used in the experiments.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left">Countries</td>
<td valign="top" align="left">Features</td>
<td valign="top" align="center">Update frequency</td>
<td valign="top" align="left">Considered period for the Covid-19 infections</td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Australia, Brazil, China, France, Germany, India, Iran, Israel, Italy, Malaysia, Russia, Saudi Arabia, Spain, United Kingdom, and United States</td>
<td valign="top" align="left">Province/state, country/region, last update, number of confirmed cases, number of recovered cases, and number of deaths</td>
<td valign="top" align="center">Daily</td>
<td valign="top" align="left">22/01/2020&#x2013;08/01/2022</td>
</tr>
</tbody>
</table>
</table-wrap>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption><p>COVID-19 infections&#x2019; data trend for the countries under study.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmed-09-871885-g003.tif"/>
</fig>
</sec>
<sec id="S3.SS4">
<title>Experiments and evaluation metrics</title>
<p>To predict the COVID-19 infections for the countries under study, we used our proposed system that selected the most accurate machine/deep learning model based on the temporal distribution of the infection evolution for a country (<xref ref-type="bibr" rid="B31">31</xref>) as stated in <xref ref-type="fig" rid="F1">Figure 1</xref>. For each country under study, we compared the performance of the model selected using our proposed system with the outperforming model(s) in the literature for that country (<xref ref-type="table" rid="T1">Table 1</xref>). <xref ref-type="table" rid="T3">Table 3</xref> presents the selected model and the models used for the comparison for each country. The description and the parameters for the models are listed in <xref ref-type="table" rid="T4">Table 4</xref>.</p>
<table-wrap position="float" id="T3">
<label>TABLE 3</label>
<caption><p>Prediction models used for the countries under study.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left">Country</td>
<td valign="top" align="center">Infection&#x2019;s trend</td>
<td valign="top" align="center">Automated AI selected model</td>
<td valign="top" align="center">Model(s) used for comparison</td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">China</td>
<td valign="top" align="center">Exponential + linear</td>
<td valign="top" align="center">HLT</td>
<td valign="top" align="center">Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">France</td>
<td valign="top" align="left"/><td valign="top" align="left"/><td valign="top" align="center">ARIMA (<xref ref-type="bibr" rid="B27">27</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Germany</td>
<td valign="top" align="left"/><td valign="top" align="left"/><td valign="top" align="center">Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Italy</td>
<td valign="top" align="left"/><td valign="top" align="left"/><td valign="top" align="center">ARIMA (<xref ref-type="bibr" rid="B24">24</xref>, <xref ref-type="bibr" rid="B27">27</xref>) and Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Malaysia</td>
<td valign="top" align="left"/><td valign="top" align="left"/><td valign="top" align="center">ARIMA (<xref ref-type="bibr" rid="B28">28</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Australia</td>
<td valign="top" align="center">Polynomial</td>
<td valign="top" align="center">QT</td>
<td valign="top" align="center">LSTM (<xref ref-type="bibr" rid="B26">26</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Iran</td>
<td valign="top" align="left"/><td valign="top" align="left"/><td valign="top" align="center">Bi-GRU (<xref ref-type="bibr" rid="B26">26</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Russia</td>
<td valign="top" align="left"/><td valign="top" align="left"/><td valign="top" align="center">Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Spain</td>
<td valign="top" align="left"/><td valign="top" align="left"/><td valign="top" align="center">SutteARIMA (<xref ref-type="bibr" rid="B23">23</xref>), Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>) and ARIMA (<xref ref-type="bibr" rid="B27">27</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">UK</td>
<td valign="top" align="left"/><td valign="top" align="left"/><td valign="top" align="center">Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">US</td>
<td valign="top" align="center">Linear</td>
<td valign="top" align="center">LT</td>
<td valign="top" align="center">ARIMA (<xref ref-type="bibr" rid="B24">24</xref>) and Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Israel</td>
<td valign="top" align="left"/><td valign="top" align="left"/><td valign="top" align="center">Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Brazil</td>
<td valign="top" align="center">Exponential + damping</td>
<td valign="top" align="center">DT</td>
<td valign="top" align="center">Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">India</td>
<td valign="top" align="left"/><td valign="top" align="left"/><td valign="top" align="center">Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>)</td>
</tr>
<tr>
<td valign="top" align="left">Saudi Arabia</td>
<td valign="top" align="left"/><td valign="top" align="left"/><td valign="top" align="center">ARIMA (<xref ref-type="bibr" rid="B29">29</xref>)</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap position="float" id="T4">
<label>TABLE 4</label>
<caption><p>Description and parameters of the prediction models used in the experiments.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left">Model</td>
<td valign="top" align="left">Description</td>
<td valign="top" align="left">Parameter</td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">HLT</td>
<td valign="top" align="left">Allows forecasting of data with a trend. It is exponential smoothing applied to both the average value in the series (level) as well as the trend (<xref ref-type="bibr" rid="B47">47</xref>).</td>
<td valign="top" align="left">Smoothing parameters for level (&#x03B1;) and trend (&#x03B2;)</td>
</tr>
<tr>
<td valign="top" align="left">QT</td>
<td valign="top" align="left">Develops a polynomial relationship between time and the infection data (<xref ref-type="bibr" rid="B31">31</xref>).</td>
<td valign="top" align="left">Degree of polynomial</td>
</tr>
<tr>
<td valign="top" align="left">LT</td>
<td valign="top" align="left">Develops a linear relationship between time and the infection data (<xref ref-type="bibr" rid="B31">31</xref>). It is suitable for the time series where the local mean is increasing gradually over time at a constant rate.</td>
<td valign="top" align="left">Not applicable</td>
</tr>
<tr>
<td valign="top" align="left">DT</td>
<td valign="top" align="left">Extends the HLT model by adding a damping parameter that dampens the steep increasing forecast of HLT to a flat trend in the future (<xref ref-type="bibr" rid="B46">46</xref>).</td>
<td valign="top" align="left">Smoothing parameters for level (&#x03B1;), trend (&#x03B2;), and damping parameter (&#x03A6;)</td>
</tr>
<tr>
<td valign="top" align="left">LSTM</td>
<td valign="top" align="left">LSTM is a recurrent neural network that is capable of learning long-term dependencies. The main concepts of LSTM are the cell state and the gates. The cell state acts as a data transmission channel that transfers relative information to the chain of neural networks. Gates are the way to decide on what information to keep or forget based on the relevance during the training.</td>
<td valign="top" align="left">input size, number of neurons, epochs, activation function, and optimizer</td>
</tr>
<tr>
<td valign="top" align="left">Bi-LSTM</td>
<td valign="top" align="left">A recurrent neural network model consisting of two LSTM networks, one in forward direction (previous timestamp to future) and backward direction (future to previous timestamps).</td>
<td valign="top" align="left"/></tr>
<tr>
<td valign="top" align="left">Bi-GRU</td>
<td valign="top" align="left">A neural network model consisting of two GRU networks, one taking input in forward direction and the other in backward direction. It is a bidirectional recurrent neural network consisting of input and forget gates. GRU are similar to LSTM cells but do not maintain an internal cell state</td>
<td valign="top" align="left"/></tr>
<tr>
<td valign="top" align="left">ARIMA</td>
<td valign="top" align="left">Combines the autoregressive (AR) and the moving average (MA) models (<xref ref-type="bibr" rid="B29">29</xref>). AR develops a linear regression model with lagged infections as the independent variables and the MA develops a linear regression model using lagged prediction errors as the independent variables. A non-stationary time series data trend should be transformed into a stationary one, using differencing, to apply ARIMA.</td>
<td valign="top" align="left">Orders of lag observations (p), differencing (d), and moving average (q)</td>
</tr>
<tr>
<td valign="top" align="left">SutteARIMA</td>
<td valign="top" align="left">Averages alpha-Sutte and ARIMA prediction models (<xref ref-type="bibr" rid="B23">23</xref>). Alpha-Sutte is based on the moving average method and uses the infection&#x2019;s data for the past 4 timestamps to predict infection for the next timestamp.</td>
<td valign="top" align="left">Orders of lag observations (p), differencing (d), and moving average (q)</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>To develop the prediction models, we create a separate dataset for each considered country. We use 70% of the dataset (i.e., 22/01/2020&#x2014;06/06/2021) for training (develop) the model and 30% of the dataset (i.e., 07/06/2021&#x2013;08/01/2022) for validating the developed model. We first developed a model for each country using the training dataset for that country. We then validated the developed model by predicting the number of infections for the validation period, i.e., 07/06/2021&#x2013;08/01/2022, and comparing the predicted values with the actual ones. In addition, we developed the outperforming model(s) for each country under study based on the literature (<xref ref-type="table" rid="T1">Table 1</xref>) and predicted the infections using the developed model(s). We evaluate the performance of the models in terms of RMSE and MAPE that are computed using Equations (1) and (2), respectively.</p>
<disp-formula id="S3.E1"><label>(1)</label><mml:math id="M1"><mml:mrow><mml:mrow><mml:mi>R</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>M</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>S</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>E</mml:mi></mml:mrow><mml:mo>=</mml:mo><mml:msqrt><mml:mfrac><mml:mrow><mml:msubsup><mml:mo largeop="true" symmetric="true">&#x2211;</mml:mo><mml:mrow><mml:mi>T</mml:mi><mml:mo>=</mml:mo><mml:mn>1</mml:mn></mml:mrow><mml:mi>n</mml:mi></mml:msubsup><mml:msup><mml:mrow><mml:mo>(</mml:mo><mml:mrow><mml:mrow><mml:mi>I</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>n</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>f</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>e</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>c</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>t</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>i</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>o</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>n</mml:mi><mml:mo>&#x2062;</mml:mo><mml:msubsup><mml:mi>s</mml:mi><mml:mi>T</mml:mi><mml:mrow><mml:mi>a</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>c</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>t</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>u</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>a</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>l</mml:mi></mml:mrow></mml:msubsup></mml:mrow><mml:mo>-</mml:mo><mml:mrow><mml:mi>I</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>n</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>f</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>e</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>c</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>t</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>i</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>o</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>n</mml:mi><mml:mo>&#x2062;</mml:mo><mml:msubsup><mml:mi>s</mml:mi><mml:mi>T</mml:mi><mml:mrow><mml:mi>p</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>r</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>e</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>d</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>i</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>c</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>t</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>e</mml:mi><mml:mo>&#x2062;</mml:mo><mml:mi>d</mml:mi></mml:mrow></mml:msubsup></mml:mrow></mml:mrow><mml:mo>)</mml:mo></mml:mrow><mml:mn>2</mml:mn></mml:msup></mml:mrow><mml:mi>n</mml:mi></mml:mfrac></mml:msqrt></mml:mrow></mml:math></disp-formula>
<disp-formula id="S3.E2"><label>(2)</label><mml:math id="M2"><mml:mrow><mml:mi>M</mml:mi><mml:mi>A</mml:mi><mml:mi>P</mml:mi><mml:mi>E</mml:mi><mml:mo>=</mml:mo><mml:mrow><mml:mo>(</mml:mo><mml:mrow><mml:mfrac><mml:mn>1</mml:mn><mml:mi>n</mml:mi></mml:mfrac><mml:mstyle displaystyle='true'><mml:msubsup><mml:mo>&#x2211;</mml:mo><mml:mrow><mml:mi>T</mml:mi><mml:mo>=</mml:mo><mml:mn>1</mml:mn></mml:mrow><mml:mi>n</mml:mi></mml:msubsup><mml:mrow><mml:mfrac><mml:mrow><mml:mrow><mml:mo>|</mml:mo><mml:mrow><mml:mi>I</mml:mi><mml:mi>n</mml:mi><mml:mi>f</mml:mi><mml:mi>e</mml:mi><mml:mi>c</mml:mi><mml:mi>t</mml:mi><mml:mi>i</mml:mi><mml:mi>o</mml:mi><mml:mi>n</mml:mi><mml:msubsup><mml:mi>s</mml:mi><mml:mi>T</mml:mi><mml:mrow><mml:mi>a</mml:mi><mml:mi>c</mml:mi><mml:mi>t</mml:mi><mml:mi>u</mml:mi><mml:mi>a</mml:mi><mml:mi>l</mml:mi></mml:mrow></mml:msubsup><mml:mo>&#x2212;</mml:mo><mml:mi>I</mml:mi><mml:mi>n</mml:mi><mml:mi>f</mml:mi><mml:mi>e</mml:mi><mml:mi>c</mml:mi><mml:mi>t</mml:mi><mml:mi>i</mml:mi><mml:mi>o</mml:mi><mml:mi>n</mml:mi><mml:msubsup><mml:mi>s</mml:mi><mml:mi>T</mml:mi><mml:mrow><mml:mi>p</mml:mi><mml:mi>r</mml:mi><mml:mi>e</mml:mi><mml:mi>d</mml:mi><mml:mi>i</mml:mi><mml:mi>c</mml:mi><mml:mi>t</mml:mi><mml:mi>e</mml:mi><mml:mi>d</mml:mi></mml:mrow></mml:msubsup></mml:mrow><mml:mo>|</mml:mo></mml:mrow></mml:mrow><mml:mrow><mml:mi>I</mml:mi><mml:mi>n</mml:mi><mml:mi>f</mml:mi><mml:mi>e</mml:mi><mml:mi>c</mml:mi><mml:mi>t</mml:mi><mml:mi>i</mml:mi><mml:mi>o</mml:mi><mml:mi>n</mml:mi><mml:msubsup><mml:mi>s</mml:mi><mml:mi>T</mml:mi><mml:mrow><mml:mi>a</mml:mi><mml:mi>c</mml:mi><mml:mi>t</mml:mi><mml:mi>u</mml:mi><mml:mi>a</mml:mi><mml:mi>l</mml:mi></mml:mrow></mml:msubsup></mml:mrow></mml:mfrac></mml:mrow></mml:mstyle></mml:mrow><mml:mo>)</mml:mo></mml:mrow><mml:mo>&#x00D7;</mml:mo><mml:mn>100</mml:mn><mml:mi>&#x0025;</mml:mi></mml:mrow></mml:math></disp-formula>
<p>where n is the total number of days for which the infections are predicted</p>
<p>To tune the hyperparameters for the considered models, we implement each model with varying parameters&#x2019; values and select the values that result in the least MAPE. In particular, to obtain the values of &#x03B1; and &#x03B2; parameters for HLT model, we implement the model with varying values of the parameters between [0, 1] at an interval of 0.1, i.e., (&#x03B1; = 0, &#x03B2; = 0), (&#x03B1; = 0, &#x03B2; = 0.1), &#x2026;, (&#x03B1; = 0.2, &#x03B2; = 0), (&#x03B1; = 0.2, &#x03B2; = 0.1),&#x2026; (&#x03B1; = 1, &#x03B2; = 1). The combination of values that return the minimum MAPE is selected. For QT, we implement the model for varying degrees of polynomial between [1, 10] and selected the degree resulting in the least MAPE value. To obtain the values of &#x03B1;, &#x03B2;, &#x00D8; parameters for the DT model, we implement the model with varying values of the parameters between [0, 1] at an interval of 0.1 and selected the combination of values that return the minimum MAPE. To obtain the values of input size, number of neurons, epochs, activation function, and optimizer for LSTM, Bi-LSTM, and Bi-GRU models, we first determine the values of input size, number of neurons, and epochs by brute-force method while using Rectified Linear Unit (ReLU) activation function and Adaptive Movement Estimation (Adam) optimizer. We then vary the activation function and optimizer by keeping other parameters constant at their optimal values. The input sizes of 10, 50, 100, 200, and 250 are considered for the experiments. The different values used for epochs are 100, 200, 300, 400, and 500. However, for Italy, 1500 epochs are used as the model did not converge with 500 epochs. The number of neurons is varied from 100 to 1,000 at an interval of 100. The different activation functions used are ReLU, Softplus, Softmax, Softsign, Scaled Exponential Linear Unit (SELU), Linear, Hard_sigmoid, Sigmoid, Hyperbolic Tangent (Tanh), and Exponential Linear Unit (ELU). The optimizers used for tuning are Adam, Adadelta, Adaptive Gradient (AdaGrad), Adamax, Nesterov-accelerated Adaptive Moment Estimation (Nadam), Stochastic Gradient Descent (SGD), and Root Mean Square Propagation (RMSprop). The Mean Squared Error (MSE) loss function is used for LSTM, Bi-LSTM, and Bi-GRU models. To yield parameters&#x2019; values for the ARIMA and SutteARIMA models, we first check the stationarity of the infection data and determine the value of d. This is by performing the statistical augmented Dickey-Fuller (ADF) test (<xref ref-type="bibr" rid="B33">33</xref>, <xref ref-type="bibr" rid="B46">46</xref>) that checks the null hypothesis that the data is non-stationary and returns a probability score (<italic>p</italic>-value). A <italic>p</italic>-value &#x003C; 0.05 indicates that the time series is stationary. If the <italic>p</italic>-value &#x2265; 0.05 (non-stationary time series), then the time series is differenced and the ADF test is performed again. This is repeated until the time series becomes stationary. The value of d is then equal to the number of times the series is differenced. After determining the value of d, we plot the Autocorrelation Function (ACF) and Partial Autocorrelation Function (PACF) plots for the differenced time series to determine the values of q and p, respectively. The number of lags for which the ACF is outside the significant threshold represents the value of the parameter &#x201C;q&#x201D; value and the number of lags for which the PACF is outside the significant threshold represents the value of &#x201C;p.&#x201D;</p>
</sec>
</sec>
<sec id="S4" sec-type="results">
<title>Results</title>
<sec id="S4.SS1">
<title>Hyperparameter tuning</title>
<p><xref ref-type="fig" rid="F4">Figure 4</xref> shows the MAPE obtained by the HLT models, for different values of &#x03B1; and &#x03B2;, when developed for the infection data of China, France, Germany, Italy, and Malaysia. It shows that the minimum MAPE is obtained for (&#x03B1;, &#x03B2;) values of (0.1, 1.0), (0.3, 0.9), (1.0, 0.1), (1.0, 0.1), and (0.1, 0.4) for China, France, Germany, Italy, and Malaysia, respectively. We use these values to develop the prediction model for the corresponding countries. <xref ref-type="fig" rid="F5">Figure 5</xref> shows the MAPE obtained by the DT model, for different values of &#x03B1; and &#x03B2;, when developed for the infection data in Brazil, India, and Saudi Arabia. It shows that the minimum MAPE is obtained for (&#x03B1;, &#x03B2;) values of (1.0, 0.2), (1.0, 0.1), and (0.5, 0.1) for Brazil, India, and Saudi Arabia, respectively. We use these values to develop the prediction model. <xref ref-type="fig" rid="F6">Figure 6</xref> shows the training and validation losses over epochs for LSTM, Bi-LSTM, and Bi-GRU models for China, Germany, Italy, Australia, Iran, Russia, Spain, the United Kingdom, the United States, Israel, Brazil, and India. As shown in the figure, both training and validation losses converge, indicating a good fit. However, for Australia (<xref ref-type="fig" rid="F6">Figure 6D</xref>), there is a gap between the training and validation losses indicating unrepresentative training dataset. This is because the number of infections for Australia increased rapidly during the validation period, as shown in <xref ref-type="fig" rid="F3">Figure 3</xref>, which is not captured by the model develop using the training dataset. For the ARIMA model, we first perform the ADF test to check the stationarity of time series data for France, Italy, Malaysia, Spain, the United States, and Saudi Arabia. The <italic>p</italic>-values obtained for Malaysia, Spain, the United States, and Saudi Arabia after the second-order are 0.000000, 0.000000, 0.000092, and 0.000117, respectively. The <italic>p</italic>-values &#x003C; 0.05 for these countries indicate that the time series becomes stationary after second-order differencing. Consequently, the value of d is set to 2 for these countries. For France and Italy, <italic>p</italic>-values &#x003C; 0.05, i.e., 0.003894 and 0.048181, respectively, are obtained after first order differencing. However, the ACF plots for the first ordered differenced infection data of France and Italy do not converge to zero. Consequently, we differenced the time series for these countries one more time and select <italic>d</italic> = 2 for France and Italy after obtaining a <italic>p</italic>-value of 0.000000 and 0.001730, respectively. <xref ref-type="fig" rid="F7">Figure 7</xref> shows the ACF and PACF plots for the stationary infection data, i.e., after second-order differencing, for France, Italy, Malaysia, Spain, the United States, and Saudi Arabia. As depicted in <xref ref-type="fig" rid="F7">Figure 7A</xref>, 1 lag value is outside the significant threshold in the ACF plot for France indicating <italic>q</italic> = 1. Moreover, 10 values in the PACF plot are outside the threshold indicating <italic>p</italic> = 10. Similarly, (p, q) values for Italy, Malaysia, Spain, the United States, and Saudi Arabia are (5, 7), (5, 2), (6, 8), (9, 1), and (3, 1) as shown in <xref ref-type="fig" rid="F7">Figures 7B&#x2013;F</xref>), respectively. <xref ref-type="table" rid="T5">Table 5</xref> shows the optimal values of parameters for the developed models.</p>
<fig id="F4" position="float">
<label>FIGURE 4</label>
<caption><p>Performance of Holt&#x2019;s linear trend (HLT) model with varying parameters&#x2019; values for the infection data in <bold>(A)</bold> China, <bold>(B)</bold> France, <bold>(C)</bold> Germany, <bold>(D)</bold> Italy, and <bold>(E)</bold> Malaysia.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmed-09-871885-g004.tif"/>
</fig>
<fig id="F5" position="float">
<label>FIGURE 5</label>
<caption><p>Performance of damped trend (DT) model with varying parameters&#x2019; values for the infection data in <bold>(A)</bold> Brazil, <bold>(B)</bold> India, and <bold>(C)</bold> Saudi Arabia.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmed-09-871885-g005.tif"/>
</fig>
<fig id="F6" position="float">
<label>FIGURE 6</label>
<caption><p>Training and validation loss vs. epochs for long short-term memory (LSTM), bidirectional-LSTM (Bi-LSTM), and bidirectional gated recurrent unit (Bi-GRU) models after hyperparameter tuning for infection data in <bold>(A)</bold> China (Bi-LSTM), <bold>(B)</bold> Germany (Bi-LSTM), <bold>(C)</bold> Italy (Bi-LSTM), <bold>(D)</bold> Australia (LSTM), <bold>(E)</bold> Iran (B-GRU), <bold>(F)</bold> Russia (Bi-LSTM), <bold>(G)</bold> Spain (Bi-LSTM), <bold>(H)</bold> United Kingdom (Bi-LSTM), <bold>(I)</bold> United States (Bi-LSTM), <bold>(J)</bold> Israel (Bi-LSTM), <bold>(K)</bold> Brazil (Bi-LSTM), and <bold>(L)</bold> India (Bi-LSTM).</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmed-09-871885-g006.tif"/>
</fig>
<fig id="F7" position="float">
<label>FIGURE 7</label>
<caption><p>Autocorrelation function (ACF) and partial autocorrelation function (PACF) plots for the stationary infection data in <bold>(A)</bold> France, <bold>(B)</bold> Italy, <bold>(C)</bold> Malaysia, <bold>(D)</bold> Spain, <bold>(E)</bold> United States, and <bold>(F)</bold> Saudi Arabia.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmed-09-871885-g007.tif"/>
</fig>
<table-wrap position="float" id="T5">
<label>TABLE 5</label>
<caption><p>Optimal values of parameters obtained after hyperparameter tuning for the models used in the experiments.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left">Model</td>
<td valign="top" align="center">Country</td>
<td valign="top" align="center">Optimal parameters&#x2019; values</td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">HLT</td>
<td valign="top" align="center">China</td>
<td valign="top" align="center">&#x03B1; = 0.1, &#x03B2; = 1.0</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">France</td>
<td valign="top" align="center">&#x03B1; = 0.3, &#x03B2; = 0.9</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Germany</td>
<td valign="top" align="center">&#x03B1; = 1.0, &#x03B2; = 0.1</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Italy</td>
<td valign="top" align="center">&#x03B1; = 1.0, &#x03B2; = 0.1</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Malaysia</td>
<td valign="top" align="center">&#x03B1; = 0.1, &#x03B2; = 0.4</td>
</tr>
<tr>
<td valign="top" align="left">QT</td>
<td valign="top" align="center">Australia</td>
<td valign="top" align="center">Degree = 5</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Iran</td>
<td valign="top" align="center">Degree = 2</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Russia</td>
<td valign="top" align="center">Degree = 2</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Spain</td>
<td valign="top" align="center">Degree = 3</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">United Kingdom</td>
<td valign="top" align="center">Degree = 2</td>
</tr>
<tr>
<td valign="top" align="left">DT</td>
<td valign="top" align="center">Brazil</td>
<td valign="top" align="center">&#x03B1; = 1.0, &#x03B2; = 0.2, &#x03A6; = 0.99</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">India</td>
<td valign="top" align="center">&#x03B1; = 1.0, &#x03B2; = 0.1, &#x03A6; = 0.99</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Saudi Arabia</td>
<td valign="top" align="center">&#x03B1; = 0.5, &#x03B2; = 0.1, &#x03A6; = 0.99</td>
</tr>
<tr>
<td valign="top" align="left">LSTM</td>
<td valign="top" align="center">Australia</td>
<td valign="top" align="center">Input size = 250, neurons = 100, epochs = 500, activation function = ReLU, optimizer = SGD</td>
</tr>
<tr>
<td valign="top" align="left">Bi-LSTM</td>
<td valign="top" align="center">China</td>
<td valign="top" align="center">Input size = 250, neurons = 100, epochs = 500, activation function = SELU, optimizer = Adamax</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Germany</td>
<td valign="top" align="center">Input size = 250, neurons = 100, epochs = 500, activation function = SELU, optimizer = Adadelta</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Italy</td>
<td valign="top" align="center">Input size = 250, neurons = 100, epochs = 1,500, activation function = ReLU, optimizer = SGD</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Russia, Spain, United States, and Brazil</td>
<td valign="top" align="center">Input size = 250, neurons = 100, epochs = 500, activation function = ReLU, optimizer = Adadelta</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">United Kingdom</td>
<td valign="top" align="center">Input size = 250, neurons = 100, epochs = 500, activation function = Softsign, optimizer = Adadelta</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Israel</td>
<td valign="top" align="center">Input size = 250, neurons = 100, epochs = 500, activation function = ReLU, optimizer = Adam</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">India</td>
<td valign="top" align="center">Input size = 250, neurons = 100, epochs = 500, activation function = ReLU, optimizer = Nadam</td>
</tr>
<tr>
<td valign="top" align="left">Bi-GRU</td>
<td valign="top" align="center">Iran</td>
<td valign="top" align="center">Input size = 250, neurons = 100, epochs = 500, activation function = ReLU, optimizer = Adam</td>
</tr>
<tr>
<td valign="top" align="left">ARIMA</td>
<td valign="top" align="center">France</td>
<td valign="top" align="center"><italic>p</italic> = 10, <italic>q</italic> = 2, <italic>d</italic> = 1</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Italy</td>
<td valign="top" align="center"><italic>p</italic> = 5, <italic>q</italic> = 2, <italic>d</italic> = 7</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Malaysia</td>
<td valign="top" align="center"><italic>p</italic> = 5, <italic>q</italic> = 2, <italic>d</italic> = 2</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Spain</td>
<td valign="top" align="center"><italic>p</italic> = 6, <italic>q</italic> = 2, <italic>d</italic> = 8</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">United States</td>
<td valign="top" align="center"><italic>p</italic> = 9, <italic>q</italic> = 2, <italic>d</italic> = 1</td>
</tr>
<tr>
<td/>
<td valign="top" align="center">Saudi Arabia</td>
<td valign="top" align="center"><italic>p</italic> = 3, <italic>q</italic> = 2, <italic>d</italic> = 1</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="S4.SS2">
<title>COVID-19 predictions</title>
<p><xref ref-type="fig" rid="F8">Figure 8A</xref> shows COVID-19 confirmed cases for the training and validation datasets for China. In addition, it indicates the number of infections forecasted by the HLT model selected using the proposed automated AI system and the Bi-LSTM model from the literature (<xref ref-type="bibr" rid="B25">25</xref>). It shows that HLT model predicts the infections with more accuracy compared to Bi-LSTM. This is because HLT fits well the exponential + linear infection trend for China. The (MAPE, RMSE) values using HLT and Bi-LSTM models for China are (1.29, 1934.36) and (11.39, 13331.86), respectively. <xref ref-type="fig" rid="F8">Figure 8B</xref> shows the predicted infections for France using the proposed automated AI-selected HLT model and state-of-the-art ARIMA model (<xref ref-type="bibr" rid="B27">27</xref>). It shows that HLT outperforms ARIMA. As depicted in <xref ref-type="fig" rid="F8">Figure 8B</xref>, HLT model predicts with lower error for the validation period where the infection&#x2019;s trend is linear than where the trend is exponential. The prediction error for HLT increases as the infection grows exponentially toward the end of the validation period, which is not captured by the model. The (MAPE, RMSE) values using HLT and ARIMA models for France are (3.87, 702931.85) and (9.39, 1155417.17), respectively. The prediction for Germany using automated AI-selected HLT and state-of-the-art Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>) is shown in <xref ref-type="fig" rid="F8">Figure 8C</xref>. HLT outperforms Bi-LSTM as it can capture the exponential + linear infection trend for Germany. However, similar to <xref ref-type="fig" rid="F8">Figure 8B</xref>, the prediction error by HLT for Germany (<xref ref-type="fig" rid="F8">Figure 8C</xref>) increases when the validation infection data exhibits an exponential trend. The (MAPE, RMSE) values using HLT and Bi-LSTM models for Germany are (9.37, 967916.97) and (28.01, 1321353.74), respectively. <xref ref-type="fig" rid="F8">Figure 8D</xref> shows COVID-19 prediction for Italy using automated AI-selected HLT and state-of-the-art ARIMA (<xref ref-type="bibr" rid="B24">24</xref>, <xref ref-type="bibr" rid="B27">27</xref>) and Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>) models. The HLT model outperforms ARIMA and Bi-LSTM models. The (MAPE, RMSE) values using HLT, ARIMA, and Bi-LSTM models for Italy are (2.84, 389747.98), (6.56, 581053.16), and (12.41, 837410.43), respectively. The prediction results for Malaysia using our automated AI-selected HLT model and state-of-the-art ARIMA model (<xref ref-type="bibr" rid="B28">28</xref>) are presented in <xref ref-type="fig" rid="F8">Figure 8E</xref>. HLT captures the infection trend for Malaysia and outperforms ARIMA in predicting COVID-19 infections. The (MAPE, RMSE) values using HLT and ARIMA models for Malaysia are (16.37, 412523.95) and (23.23, 617834.31), respectively.</p>
<fig id="F8" position="float">
<label>FIGURE 8</label>
<caption><p><bold>(A)</bold> Forecasting of COVID-19 infections in China using automated artificial intelligence-enabled system selected Holt&#x2019;s linear trend (HLT) and state-of-the-art Bidirectional long short-term Memory (Bi-LSTM) models. <bold>(B)</bold> Forecasting of COVID-19 infections in France using Automated Artificial Intelligence-enabled system selected HLT and state-of-the-art Autoregressive Integrated Moving Average (ARIMA) models. <bold>(C)</bold> Forecasting of COVID-19 infections in Germany using Automated Artificial Intelligence-enabled system selected HLT and state-of-the-art Bi-LSTM models. <bold>(D)</bold> Forecasting of COVID-19 infections in Italy using Automated Artificial Intelligence-enabled system selected HLT and state-of-the-art ARIMA and Bi-LSTM models. <bold>(E)</bold> Forecasting of COVID-19 infections in Malaysia using Automated Artificial Intelligence-enabled system selected HLT and state-of-the-art ARIMA models. <bold>(F)</bold> Forecasting of COVID-19 infections in Australia using Automated Artificial Intelligence-enabled system selected QT and state-of-the-art LSTM models. <bold>(G)</bold> Forecasting of COVID-19 infections in Iran using Automated Artificial Intelligence-enabled system selected QT and state-of-the-art Bi-GRU models. <bold>(H)</bold> Forecasting of COVID-19 infections in Russia using Automated Artificial Intelligence- enabled system selected Quadratic Trend (QT) and state-of-the-art Bi-LSTM models. <bold>(I)</bold> Forecasting of COVID-19 infections in Spain using Automated Artificial Intelligence-enabled system selected QT and state-of-the-art ARIMA, SutteARIMA, and Bi-LSTM models. <bold>(J)</bold> Forecasting of COVID-19 infections in the United Kingdom using Automated Artificial Intelligence-enabled system selected QT and state-of-the-art Bi-LSTM models. <bold>(K)</bold> Forecasting of COVID-19 infections in the United States using Automated Artificial Intelligence-enabled system selected Linear Trend (LT) and state-of-the-art ARIMA and Bi-LSTM models. <bold>(L)</bold> Forecasting of COVID-19 infections in Israel using Automated Artificial Intelligence-enabled system selected LT and state-of-the-art Bi-LSTM models. <bold>(M)</bold> Forecasting of COVID-19 infections in Brazil using Automated Artificial Intelligence-enabled system selected Damped Trend (DT) and state-of-the-art Bi-LSTM models. <bold>(N)</bold> Forecasting of COVID-19 infections in India using Automated Artificial Intelligence-enabled system selected DT and state-of-the-art Bi-LSTM models, and <bold>(O)</bold> forecasting of COVID-19 infections in Saudi Arabia using Automated Artificial Intelligence-enabled system selected DT and state-of-the-art ARIMA models.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmed-09-871885-g008.tif"/>
</fig>
<p><xref ref-type="fig" rid="F8">Figure 8F</xref> shows the prediction results for Australia using automated AI-selected QT and state-of-the-art LSTM (<xref ref-type="bibr" rid="B26">26</xref>). The (MAPE, RMSE) values using QT and LSTM models for Australia are (20.64, 80417.79), and (68.60, 181145.56), respectively. <xref ref-type="fig" rid="F8">Figure 8G</xref> shows the prediction results for Iran using automated AI-selected QT and Bi-GRU (<xref ref-type="bibr" rid="B26">26</xref>). The (MAPE, RMSE) values using QT and Bi-GRU models for Iran are (8.54, 579794.14) and (31.90, 2086139.84), respectively. <xref ref-type="fig" rid="F8">Figure 8H</xref> shows COVID-19 predictions for Russia using automated AI-selected QT and Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>). It depicts that QT outperforms Bi-LSTM as it can capture the polynomial trend of the infection data in Russia. The (MAPE, RMSE) values using QT and Bi-LSTM models for Russia are (12.87, 941065.72) and (23.58, 2536117.98), respectively. <xref ref-type="fig" rid="F8">Figure 8I</xref> shows the prediction results for Spain using automated AI-selected QT and state-of-the-art ARIMA (<xref ref-type="bibr" rid="B27">27</xref>), SutteARIMA (<xref ref-type="bibr" rid="B23">23</xref>), and Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>). The (MAPE, RMSE) values using QT, ARIMA, SutteARIMA, and Bi-LSTM models for Spain are (5.77, 497155.75), (13.26, 825509.28), (56.48, 2804433.84), and (16.48, 1047913.19), respectively. <xref ref-type="fig" rid="F8">Figure 8J</xref> shows the prediction results for the United Kingdom using automated AI-selected QT and Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>). The (MAPE, RMSE) values using QT and Bi-LSTM models for the United Kingdom are (16.57, 1167306.58) and (27.40, 3450595.03), respectively. <xref ref-type="fig" rid="F8">Figure 8K</xref> shows the COVID19 infection prediction for the United States using LT, ARIMA (<xref ref-type="bibr" rid="B24">24</xref>), and Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>). The (MAPE, RMSE) values using LT, ARIMA, and Bi-LSTM models for the United States are (3.79, 2197376.04), (15.5, 9450564.22), and (10.99, 6337067.40) respectively. <xref ref-type="fig" rid="F8">Figure 8L</xref> shows the prediction results for Israel using automated selected LT and Bi-LSTM (<xref ref-type="bibr" rid="B25">25</xref>). The (MAPE, RMSE) values using LT and Bi-LSTM models for Israel are (9.06, 119886.19) and (20.91, 335433.23), respectively. <xref ref-type="fig" rid="F8">Figures 8M,N</xref>) show the prediction results for Brazil and India, respectively, using automated AI-selected DT models and Bi-LSTM models (<xref ref-type="bibr" rid="B25">25</xref>). They show that DT outperforms Bi-LSTM for both Brazil and India as it can accurately DT capture the exponential + damping trend of infection growth. The (MAPE, RMSE) values using DT and Bi-LSTM models for Brazil are (0.73, 175627.67) and (14.02, 3313775.77), respectively. The (MAPE, RMSE) values using DT and Bi-LSTM models for India are (4.79, 1732187.64) and (36.89, 12906730.59), respectively. <xref ref-type="fig" rid="F8">Figure 8O</xref> shows the prediction results for Saudi Arabia using automated AI selected DT and ARIMA (<xref ref-type="bibr" rid="B29">29</xref>). The (MAPE, RMSE) values using DT and ARIMA models for Saudi Arabia are (1.54, 9909.39) and (6.37, 47768.10), respectively. <xref ref-type="fig" rid="F9">Figure 9</xref> show the MAPE and RMSE obtained by the model selected using the proposed system and state-of-the-art approaches for each country under study. It shows that the selected models outperform the approaches in the literature for each country. In summary, the proposed system predicts COVID-19 infections with an average MAPE and RMSE of 7.87 and 665052.14, respectively. The average MAPE values for state-of-the-art Bi-LSTM, ARIMA, LSTM, Bi-GRU, and SutteARIMA models are 20.21, 12.38, 68.60, 31.90, and 56.48, respectively, whereas the average RMSE values are 3209972.92, 2113024.38, 181145.57, 2086139.84, and 2804433.85, respectively.</p>
<fig id="F9" position="float">
<label>FIGURE 9</label>
<caption><p>Mean absolute percentage error (MAPE) and normalized root mean squared error (RMSE) of the Automated Artificial Intelligence-enabled system selected and state-of-the-art models for the countries under study.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmed-09-871885-g009.tif"/>
</fig>
</sec>
</sec>
<sec id="S5" sec-type="discussion">
<title>Discussion</title>
<p>Time series prediction is a useful method to predict the dynamics of future infection data by using the influence of the trends, seasonality, and randomness of the historical data (<xref ref-type="bibr" rid="B31">31</xref>). Different machine learning algorithms have been used to analyze the data of epidemic and pandemic diseases such as influenzas A (H1N1), B, measles childhood disease (<xref ref-type="bibr" rid="B32">32</xref>), SARS, MERS, and COVID-19 outbreaks, at the country, regional or global level (<xref ref-type="bibr" rid="B31">31</xref>). Though any machine learning algorithm can produce reliable results at some level, time series algorithms are the most accurate approaches to studying epidemic and pandemic diseases because of their dynamic and temporal nature (<xref ref-type="bibr" rid="B33">33</xref>). Several machine learning and deep learning time series algorithms have been used in the literature to predict COVID-19 infections (<xref ref-type="bibr" rid="B23">23</xref>&#x2013;<xref ref-type="bibr" rid="B29">29</xref>). The dominant concern in predicting infections for a country is the prediction&#x2019;s accuracy, optimal resource management, and effective development of strategies. Our main goals are to (1) decide on an accurate time series learning algorithm for predictions, and (2) hyperparameter tuning for the selected algorithm. These algorithms are data-driven and are only suitable for a particular trend of the infection&#x2019;s growth. Consequently, a single algorithm cannot be applied to predict infections&#x2019; spread in different countries. For instance, Autoregressive Integrated Moving Average (ARIMA) (<xref ref-type="bibr" rid="B29">29</xref>) cannot be used for prediction when the trend of infection&#x2019;s growth linearizes/dampens over time. Furthermore, Holt&#x2019;s Linear Trend (HLT) (<xref ref-type="bibr" rid="B47">47</xref>) model gives inaccurate prediction results if there exists a seasonality behavior in the infection&#x2019;s growth. <xref ref-type="table" rid="T6">Table 6</xref> presents the limitations of the models used in the literature (<xref ref-type="table" rid="T1">Table 1</xref>). In summary, <xref ref-type="table" rid="T6">Table 6</xref> shows that no single algorithm can be used to accurately predict infections for all the countries in the world. This is because the infection trend is different from one country to another. Our proposed automated AI-enabled proactive preparedness real-time system analyzes a country&#x2019;s infection trend and selects a time-series model which captures that particular trend. Our numerical experiments and comparative analysis show that the proposed system outperforms the state-of-the-art approaches for COVID-19 prediction. In particular, the proposed system predicts the number of infections with 68.60, 58.79, 69.90, 73.21, and 89.78% less MAPE, and 65.8150.18, 55.60, 72.20, and 82.27% lower RMSE than Bi-LSTM, ARIMA, LSTM, Bi-GRU, and SutteARIMA used in the literature, respectively.</p>
<table-wrap position="float" id="T6">
<label>TABLE 6</label>
<caption><p>Limitations of time series algorithms.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left">Algorithm</td>
<td valign="top" align="left">Limitation</td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Autoregressive Integrated Moving Average (ARIMA)</td>
<td valign="top" align="left">Not suitable for infection&#x2019;s trend that becomes linear or dampens over time</td>
</tr>
<tr>
<td valign="top" align="left">SutteARIMA</td>
<td valign="top" align="left">Not suitable for infection&#x2019;s trend that increases exponentially</td>
</tr>
<tr>
<td valign="top" align="left">Holt&#x2019;s linear trend</td>
<td valign="top" align="left">Not suitable for infection&#x2019;s trend with seasonality</td>
</tr>
<tr>
<td valign="top" align="left">Trigonometric Exponential smoothing state-space model with Box-Cox transformation</td>
<td valign="top" align="left">Not suitable for infection&#x2019;s trend that increases exponentially</td>
</tr>
<tr>
<td valign="top" align="left">Cubic smoothing spline</td>
<td valign="top" align="left">Not suitable for infection&#x2019;s trend having a high difference in the number of infections between consecutive time intervals</td>
</tr>
<tr>
<td valign="top" align="left">Support vector regression</td>
<td valign="top" align="left">Not suitable for infection&#x2019;s trend with randomness</td>
</tr>
<tr>
<td valign="top" align="left">Long short-term memory (LSTM), Bi-LSTM, gated recurrent unit (GRU), and Bi-GRU</td>
<td valign="top" align="left">Time consuming, memory-intensive and the performance is sensitive to the initial values of hyperparameters</td>
</tr>
<tr>
<td valign="top" align="left">Autoregressive and Autoregressive Moving Average</td>
<td valign="top" align="left">Not suitable for infection&#x2019;s trend whose average varies over time</td>
</tr>
<tr>
<td valign="top" align="left">Moving average</td>
<td valign="top" align="left">Can only predict a consistent change in infections over time</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="S6" sec-type="conclusion">
<title>Conclusion</title>
<p>Considering the dynamicity in the temporal distribution of infections over time among different countries, a single machine learning infection prediction algorithm cannot solely yield high accuracy for all the countries, and hence different models should be adopted for predicting infections in different countries. The selection of the model for a country is the main challenge as evaluating the performance of all the algorithms for a country and then selecting the most accurate model is a complex and inefficient process. For selecting the most accurate model the trend of the infection&#x2019;s evolution for a country should be taken into consideration. Incorporating all these factors, a novel automated artificial intelligence-enabled proactive preparedness real-time system for accurate prediction of COVID-19 infection is proposed. We present the design, development, and implementation of the system. The proposed system selects the most accurate model based on the infection trend for a country, whereas the models in the literature are selected based on the popularity of the model or based on the performance of a models when used for other countries. The developed system performs efficiently, with an average reduction of 72.1% in MAPE and 65.2% in RMSE compared to state-of-the-art approaches. Consequently, the system will aid governments to tailor the precautionary measures in place to tackle a pandemic, such as COVID-19, and develop an effective plan to manage the medical resources efficiently. For future research work, a large spectrum of countries will be considered to evaluate the proposed system. In addition, efficient methods for models&#x2019; calibrations will be investigated.</p>
</sec>
<sec id="S7" sec-type="data-availability">
<title>Data availability statement</title>
<p>We used publicly available Johns Hopkins COVID-19 dataset in this study. This data is updated daily and can be found here: <ext-link ext-link-type="uri" xlink:href="https://data.humdata.org/dataset/novel-coronavirus-2019-ncov-cases">https://data.humdata.org/dataset/novel-coronavirus-2019-ncov-cases</ext-link>.</p>
</sec>
<sec id="S8">
<title>Author contributions</title>
<p>LI conceived the topic, conducted the conceptualization, design, investigation, methodology, experiments, prepared and wrote the first draft of the manuscript, and manuscript review and editing. HM participated in the investigation, experiments, and first draft preparation. YA participated in writing the security part. FF contributed to the design, methodology, and manuscript review and editing. GK contributed to the introduction and manuscript review and editing. SRBA contributed to the manuscript review and editing. All authors contributed to the manuscript revision, read, and approved the submitted version.</p>
</sec>
</body>
<back>
<sec id="S9" sec-type="funding-information">
<title>Funding</title>
<p>This research was funded by the National Water and Energy Center of the United Arab Emirates University (Grant number: 31R215).</p>
</sec>
<sec id="S10" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="S11" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<fn-group>
<fn id="footnote1">
<label>1</label>
<p><ext-link ext-link-type="uri" xlink:href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019">https://www.who.int/emergencies/diseases/novel-coronavirus-2019</ext-link> (last accessed on May 23, 2022).</p></fn>
<fn id="footnote2">
<label>2</label>
<p><ext-link ext-link-type="uri" xlink:href="https://covid19.who.int/">https://covid19.who.int/</ext-link> (last accessed on May 23, 2022).</p></fn>
<fn id="footnote3">
<label>3</label>
<p><ext-link ext-link-type="uri" xlink:href="https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html">https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html</ext-link> (last accessed on May 16, 2022).</p></fn>
<fn id="footnote4">
<label>4</label>
<p><ext-link ext-link-type="uri" xlink:href="https://www.cdc.gov/flu/pandemic-resources/pandemic-timeline-1930-and-beyond.htm">https://www.cdc.gov/flu/pandemic-resources/pandemic-timeline-1930-and-beyond.htm</ext-link> (last accessed on May 16, 2022).</p></fn>
<fn id="footnote5">
<label>5</label>
<p><ext-link ext-link-type="uri" xlink:href="https://apps.nsa.gov/iaarchive/programs/iad-initiatives/cnsa-suite.cfm">https://apps.nsa.gov/iaarchive/programs/iad-initiatives/cnsa-suite.cfm</ext-link> (last accessed on May 16, 2022).</p></fn>
<fn id="footnote6">
<label>6</label>
<p><ext-link ext-link-type="uri" xlink:href="https://data.humdata.org/dataset/novel-coronavirus-2019-ncov-cases">https://data.humdata.org/dataset/novel-coronavirus-2019-ncov-cases</ext-link> (last accessed on May 16, 2022).</p></fn>
</fn-group>
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