Remote patient management is possible for mild COVID-19 cases

  • Huang S & al.
  • Telemed J E Health
  • 1 Apr 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Remote-based, multidisciplinary-guided, self-management of suspected or confirmed COVID-19 provides effective source control and may offer an alternative to onsite screening and postdischarge follow-up during severe epidemic stages.

Why this matters

  • Lesion resolution is slower than clinical symptom improvement in patients with milder COVID-19, highlighting the likelihood for late CT changes and symptom recurrence.
  • Given increasing numbers of patients who are homebound with novel coronavirus pneumonia, monitored self-quarantine helps reduce patient mobility and frees resources for severely ill patients.

Key points

  • 2 case descriptions, both involving medical staff with prior quarantine, adherence knowledge.
  • Patients were instructed to:
    • Ventilate room twice daily, provide covered garbage bin.
    • Clean surfaces with 1000 g/L chlorinated disinfectant or 75% alcohol/daily, wash hands frequently.
    • Sterilize eating utensils.
    • Sterilize/wash clothing daily. 
  • Protocol:
    • Multidisciplinary team, WeChat communication group, online quarantine observation form (drop-down menu) for symptoms/severity (recorded by provided thermometer, portable oximeter).
    • Monitoring provided information on medication needs, changes in labs, blood oxygen saturation, heart rate.
    • Nursing staff monitored quarantine, diet, exercise, patient needs.
    • Patients returned for follow-up CT; despite clinical improvement by day 11, CT (initially normal at symptom onset) showed ground-glass opacity expansion.
  • Funding: Huazhong University of Science and Technology, China.

Limitations

  • Self-report bias.
  • Limited generalizability.