Abstract
BackgroundMost patients with coronavirus disease (COVID-19) who show mild symptoms are sent home by physicians to recover. However, the condition of some of these patients becomes severe or critical as the disease progresses.ObjectiveThe aim of this study was to evaluate a telemedicine model that was developed to address the challenges of treating patients with progressive COVID-19 who are home-quarantined and shortages in the medical workforce.MethodsA telemedicine system was developed to continuously monitor the progression of home-quarantined patients with COVID-19. The system was built based on a popular social media smartphone app called WeChat; the app was used to establish two-way communication between a multidisciplinary team consisting of 7 medical workers and 188 home-quarantined individuals (including 74 confirmed patients with COVID-19). The system helped patients self-assess their conditions and update the multidisciplinary team through a telemedicine form stored on a cloud service, based on which the multidisciplinary team made treatment decisions. We evaluated this telemedicine system via a single-center retrospective study conducted at Tongji Hospital in Wuhan, China, in January 2020.ResultsAmong 188 individuals using the telemedicine system, 114 (60.6%) were not infected with COVID-19 and were dismissed. Of the 74 confirmed patients with COVID-19, 26 (35%) recovered during the study period and voluntarily stopped using the system. The remaining 48/76 confirmed patients with COVID-19 (63%) used the system until the end of the study, including 6 patients whose conditions progressed to severe or critical. These 6 patients were admitted to hospital and were stabilized (one received extracorporeal membrane oxygenation support for 17 days). All 74 patients with COVID-19 eventually recovered. Through a comparison of the monitored symptoms between hospitalized and nonhospitalized patients, we found prolonged persistence and deterioration of fever, dyspnea, lack of strength, and muscle soreness to be diagnostic of need for hospitalization.ConclusionsBy continuously monitoring the changes in several key symptoms, the telemedicine system reduces the risks of delayed hospitalization due to disease progression for patients with COVID-19 quarantined at home. The system uses a set of scales for quarantine management assessment that enables patients to self-assess their conditions. The results are useful for medical staff to identify disease progression and, hence, make appropriate and timely treatment decisions. The system requires few staff to manage a large cohort of patients. In addition, the system can solicit help from recovered but self-quarantined medical workers to alleviate shortages in the medical workforce and free healthy medical workers to fight COVID-19 on the front line. Thus, it optimizes the usage of local medical resources and prevents cross-infections among medical workers and patients.
Highlights
Since its outbreak in December of 2019, coronavirus disease (COVID-19) has spread worldwide, causing more than 5 million infections and tens of thousands of deaths in the course of three months [1]
By continuously monitoring the changes in several key symptoms, the telemedicine system reduces the risks of delayed hospitalization due to disease progression for patients with COVID-19 quarantined at home
The results are useful for medical staff to identify disease progression and, make appropriate and timely treatment decisions
Summary
Since its outbreak in December of 2019, coronavirus disease (COVID-19) has spread worldwide, causing more than 5 million infections and tens of thousands of deaths in the course of three months [1]. In cities that were severely affected by COVID-19, such as Wuhan (China), Lombardy (Italy), and New York City (United States) [1], local medical capacities were quickly depleted by large numbers of patients who hurried to hospitals for treatment. To prevent collapse of the global health care system, many countries have advocated for infected patients with mild symptoms to stay home and self-quarantine [3]. It has been observed that the condition of some home-quarantined patients becomes severe or critical as the disease progresses. Home quarantine can delay timely treatment and hospitalization of these patients, which may lead to their death. Most patients with coronavirus disease (COVID-19) who show mild symptoms are sent home by physicians to recover. The condition of some of these patients becomes severe or critical as the disease progresses
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