By Dr Gajan Srikanthan, Director of Clinical Pathways, Lumeon
Over the last few weeks, more has been learned about the clinical progression of COVID-19. Globally, nearly 1 million confirmed cases of COVID-19 have been reported, with the spectrum of infection ranging from mild to critical, and most infections not being severe.
In a report from the Chinese Centre for Disease Control and Prevention, they estimated that 80% of cases were mild (no or mild pneumonia), about 15% were severe (e.g. with dyspnea, hypoxia or >50 percent lung involvement on imaging) and 5% critical (e.g. with respiratory failure, shock, or multi–organ dysfunction) .
Patients may develop dyspnea and hypoxemia which can quickly progress to acute respiratory distress syndrome (ARDS), the major complication in patients with severe disease.
In one study of 138 patients hospitalized in Wuhan following the onset of symptoms, dyspnea developed after a median of five days, hospital admission occurred after a median of seven days, and ARDS developed in 20 percent after a median of eight days. Among all patients, a range of 3% to 17% developed ARDS compared to a range of 20% to 42% for hospitalized patients and 67% to 85% for patients admitted to the ICU .
Clinicians must be aware of the potential for non-hospitalized patients to rapidly deteriorate a week or so after illness onset.
In normal circumstances, COVID-19 patients with a mild to moderate clinical presentation may be admitted to hospital for observation, especially if they have difficulty breathing or multiple comorbidities, or their primary care physician given explicit instructions to monitor them.
But these are not normal times. Health services are being pushed to the limit, especially in hospitals with EDs and ICUs. As wards fill up, with the sickest patients requiring ventilatory support, and clinicians focused on caring for these patients, there is a need for some sort of safety-net for those patients where there is no longer any room at the inn.
This is exactly the case we found with one of our customers – a large, not-for-profit, public health system. Their EDs are bearing the brunt of the rapid increase in cases, with queues of 150-people or more a common occurrence outside, as patients wait for assessment and treatment.
Our customer was concerned about those patients they were sending home with mild or moderate symptoms, knowing their ability to follow-up with these patients would be difficult given the current situation. What they wanted was a way of monitoring these patients’ level of breathing difficulty remotely and escalating them to clinical staff for telephone or video call review if there was any indication of deterioration.
The Lumeon team jumped into action, working relentlessly to deliver a solution for our customer within 7 days, driven by the opportunity to contribute to the care of COVID-19 patients and in some small way to help the clinical teams that are working tirelessly to stem the tide.
So, what did we build?
We built a Remote Home Monitoring Solution that ED doctors can easily signpost patients towards:
- Patients complete an assessment questionnaire either via mobile or on the website.
- The system captures their symptoms and medical problems and is used to calculate their underlying morbidity risk.
- Patients are contacted twice a day via SMS to ask them 3 simple questions about their breathing.
- Based on their replies and underlying morbidity risk, the system assigns them a callback priority status.
- A patient’s call back status may change from day-to-day based upon their responses.
- These can all be monitored and tracked by medical teams through a bespoke user interface, with high-risk patients flagged for priority call back.
- Doctors can record notes from their calls, as well as scheduling calls for patients that require daily review.
Patients who do not require a call because their morbidity risk and SMS responses do not require it, continue to be monitored twice daily by the system. If they report their breathing has been near normal for several consecutive days, they are taken off the monitoring pathway, with the proviso that they can re-enroll if their symptoms return. Similarly, if a patient is referred to hospital, a record of the referral is captured, and the patient removed from the system.
This was a great project to work on, and I am so proud of the dedication, passion, and professionalism of the Lumeon team. They moved heaven and earth to get this solution in place, and we all look forward to seeing the positive impact it has on patients and the clinicians that care for them.
If you would like to know more about our COVID-19 Remote Home Monitoring Solution, please contact us using the form below or visit our dedicated Remote Home Monitoring page.
1. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020.
2. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020.