Novel approaches to combat the impact of COVID-19

Telemedicine and mhealth technologies could act as bridge between the patients, communities, and healthcare workforce, says Dr Vikrant Kanwar

Non-pharmaceutical interventions, Public health, COVID-19, WHO, Heallthcare workforce, Dr Vikrant Kanwar

On March 11, Novel Covid-19 was declared  as pandemic by WHO. The latest report assessed the potential role of a number of public health measures – so-called non-pharmaceutical interventions (NPIs) aimed at reducing contact rates in the population and thereby reducing transmission of the virus. Two fundamental strategies are possible: (a) mitigation, which focuses on slowing but not necessarily stopping epidemic spread – reducing peak healthcare demand while protecting those most at risk of severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely.

Each policy has major challenges. We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. It indicates that various non pharmaceutical interventions like social distancing, quarantines, shutdown of educational institutions other public places could be beneficial in the present scenario. There are  constrained closure of a hospital in India after doctors test positive. There are absenteeism of the healthcare workforce, and even patients flee from the hospitals under fear. The health authorities are alert but well exhausted to trace the contacts.

There are advocacy for  performing only non-elective cases in the hospital. Under  these circumstances, the healthcare policy makers in a dilemmatic where one side the suspected  patients of COVID-19 has to be taken care of and if severe then treated with the standard protocols and on the other side, there are patients,who need optimum care for other chronic  and minor ailments. In such a situatiun, what’s the options available for healthcare policy makers ? Do the telemedicine and mhealth play the role as an alternative care delivery model for masses

The way forward strategies:
In present scenario, we propose the novel telemedicine and m Health approaches to combat the impact of COVID-19 .
1.Virtual OPDs and virtual physical examinations: Oe may envisage the virtual opds kiosks in the opds of the tertiary care hospitals for screening of the patients. The patients may use mhealth technologies for their consultations with the doctors. Only patients who are screened  and needs physical interventions will be asked for the physical examination and further management. In this way, one can avoid  60-70 % of the influx of the hospital and the patients who requires care for their chronic /minor ailments would not be excluded or under risk.

2.Online registrations of the patients in  hospitals: The facility for online appointments through mhealth tools be encouraged for social distancing and to avoid unnecessary traffic in the hospitals. This approach is more relevant in the context of developing countries as developed countries have already placed online appointment systems in their hospitals.

3 .Virtual indoors of hospitals: The indoors of the hospital should equipped with the telemedicine kiosks.This will decrease the exposure of the patients with the unnecessary movements in the indoor areas.Also, it will reduce the requirement of healthcare workforce at each indoor wings.

4.Telemonitoring in critical care  Areas of the hospital:by using the mhealth and ehealth interventions, the risks involved in the critical care areas could be reduced. the telemonitoring has already been proved ,an effective way  of  critical care.

5.Quarantine /isolation areas: The telemedicine kiosks be placed at the quarantine areas for effective monitoring of the patients.

6.Community telemedicine kiosks: This approach could be used at the residential areas. It will help in social distancing of the people and influx to the hospitals. The community could take care of their illnesses at their doorstep and if some suspect of COVID-19 comes into contact, it could be easily traced out. The  other public places like commercial complexes, airports and railway stations could also be equipped with similar kiosks for ready help. One caution is that this facility should take care of one person at a time and all the preventive measures like universal precaution are to be followed by the operating individual.

7.Electronic Lab Reportings: All lab reporting systems should be electronic and could be accessed through the mobile phones of the patient and patient could produce  the reports to the doctors through teleconsultations. it will  reduce the influx, to the healthcare facilities.

8.Mhealth  and social media:The mobile tools could be used as the awareness tools for patients, caregivers, healthcare professionals and the communities. One word of caution is, every information supplied to social media should be authentic and source should be mention in that information. This will reduce the infodemic and fear and stress in the communities.

In  novel COVID =9  pandemic, telemedicine and mHealth technologies could act as bridge between the patients, communities and healthcare workforce. It may act as media for reinforcing the non pharmaceutical interventions(NPI’s) to combat the transmission of virus. Till now, the  healthcare policy makers around the globe are eying on the tracing and  care of the patients infected with COVID19. However , there are chances that if prolonged NPI s are required, for curbing the COVID-19 menace, the healthcare demand for other medical conditions will be increased in upcoming months. It is wise if the policy makers envision such demanding situation now and start thinking of alternative healthcare delivery model by placing telemedicine and m health set ups to meet out the emergent  COVID 19 pandemic as well as taking care of other healthcare needs of the populations. The emergency telemedicine is the latest term in telemedicine domain. The right time has arrived to test the effectiveness of emergency telemedicine. On the other side, COVID 19 has created the circumstances to testify and establish the use of telemedicine and m health technologies ,as effective alternative healthcare model for larger populations.

Dr Vikrant Kanwar  isAssistant Professor& Head, Deptt of Hospital Administration, Dr Rajendra Prasad Government Medical College & Hospital, Kangra, Himachal Pradesh.