Novel Coronavirus (COVID-19): Leveraging Telemedicine to Optimize Care While Minimizing Exposures and Viral Transmission

Chauhan, Vivek; Galwankar, Sagar; Arquilla, Bonnie; Garg, Manish; Somma, Salvatore Di; El-Menyar, Ayman; Krishnan, Vimal; Gerber, Joel; Holland, Reuben; Stawicki, Stanislaw P.

options. Although the ultimate solution to the COVID-19 infection will be multifaceted, one important avenue that has not yet been explored fully is to leverage existing technologies to facilitate optimal care delivery while minimizing the risk of direct human-to-human exposure. In this context, telemedicine represents an attractive, effective, and affordable option. Moreover, this technology is of critical importance when one considers the consequences of health-care providers contracting COVID-19 as a result of direct exposure; something that can be especially devastating in low-resource areas or under the circumstances of massive stress to the existing health-care infrastructure and staff. [22] When movement is restricted throughout the world and entire cities are quarantined, affected populations are susceptible to increased stresses of daily life, unexpected economic burdens, communicable and noncommunicable diseases, and various mental health sequelae. [23] [24] [25] Consequently, unique and innovative solutions are called for to help address the critical needs of not only those acutely ill with COVID-19 but also all others who may require medical attention but are unable to receive it due to limited access or lack of resources. Under such conditions, telemedicine services (TMSs) become a critical asset, with important implications across the entire health-care delivery spectrum. The use of TMS offers several advantages, especially in the setting of nonurgent/routine care and in situations where services do not require direct provider-patient interaction, such as focused/abbreviated medical consultations or mental health visits. [26] [27] [28] This, in turn, reduces resource use across the already stressed health-care infrastructure, improves access to care, and at the same time minimizes the risk of direct person-to-person transmission of the infectious agent. [29] [30] [31] [32] Furthermore, the associated reduction in resource consumption due to the lower need for personal protective equipment can amount to substantial financial savings when considered at national, continental, or global scale. [33, 34] Based on the above rationale, the availability of TMS can become a critical need for populations and patients affected by the COVID-19 infection, especially when under active quarantine. Enabling patients to consult a health-care provider via teleconferencing, in real-time, to allay one's fear and anxiety, seek advice regarding their routine health problems, and learn self-care, all become critically important in the setting of hospitals and clinics being overwhelmed with more acute complaints. [35] [36] [37] Using tailored approaches, TMS providers can remotely identify patients who may require further escalation of care. Thus, TMS can be a powerful gate-keeping and coordination mechanism to ensure more appropriate use of provider offices, emergency departments (EDs), and hospitals, as understood within the above broader context. [36, [38] [39] [40] The overall emergency implementation of TMS can also be augmented by the addition of point-of-care clinical assessment and diagnostic testing, further strengthening the efficacy of the emergency response infrastructure. [41, 42] Spatiotemporal analyses of telehealth data, specifically those focusing on calls regarding the complaint of "fever," have in the past provided a timely and useful picture of the evolution of a national influenza outbreak in the United Kingdom (UK). [43] The