Telemedicine Can Offer Effective COVID-19 Treatment And Alleviate Burdens on Hospitals

Treating certain COVID-19 patients virtually—rather than in person—can help the strain on medical facilities and healthcare providers while still safely managing the illness, new research shows. The findings may offer a path to relief for hospitals, clinics, and providers across the country who have been overwhelmed throughout the COVID-19 pandemic.

The study, published in the Journal of Telemedicine and Telecare, found that monitoring sick people remotely can effectively treat symptoms while preventing unnecessary hospitalization, allowing patients to maintain the isolation precautions that reduce spread of the virus.

"Home monitoring programs for COVID-19 have the potential to provide excellent in-home care, reduce unnecessary emergency room visits and hospitalizations, and they allow for an easy escalation of care for deteriorating patients," Andrew Bryant, MD, a clinical assistant professor of internal medicine at the University of Iowa Carver College of Medicine and lead author on the study, told Health.

Here's what you need to know about telemedicine treatment for COVID-19.

The Shift to More Widely Accepted Use of Telemedicine

Telemedicine is the use of two-way communication technology, such as video chats and texting, to provide clinical health care remotely. Prior to the pandemic, telemedicine was less common, especially among sick patients whose conditions warranted in-person monitoring.

"Typically the thought was, if you're slightly sick, you should stay in the hospital," says Rahul Sharma, MD, MPH, chairman of the department of emergency medicine at Weill Cornell Medicine and founder and executive director of the Center for Virtual Care at Weill Cornell Medicine. "The entire concept of being able to go home and receive high-quality care wasn't always accepted."

A variety of developments, however, have altered the landscape and brought about a significant uptick in acceptance of this type of care among patients–not the least of which is the social distancing necessities associated with the COVID-19 pandemic. Social distancing required more widespread use of telemedicine, and that use has not faded as the pandemic wanes. Data from the global consulting firm McKinsey & Company shows that telehealth utilization is now 38 times higher than it was prior to the pandemic's outbreak.

But along with increased consumer willingness to engage in telehealth, there's also been increased acceptance of this approach among providers themselves, and finally, there's been regulatory changes that are enabling greater access to this kind of treatment, according to McKinsey & Company. This includes, for example, the Centers for Medicare & Medicaid Services expanding its reimbursable telehealth codes for physicians.

"During the tragedy of the pandemic, telehealth offered a bridge to care, and now it offers a chance to reinvent virtual and hybrid virtual/in-person care models, with a goal of improved healthcare access, outcomes, and affordability," said the McKinsey study.

How is Telemedicine Being Used to Treat COVID-19

In March 2020, the University of Iowa Health Care system launched a telemedicine program that involved closely monitoring patients infected with COVID-19 remotely, in order to prevent strain on the hospital. Patients were provided kits with a blood pressure cuff, pulse oximeter that also measured heart rate, and a log sheet for tracking vital signs and COVID-19 symptoms.

Along with these self-monitoring resources, the program included virtual visits with healthcare providers. Family medicine doctors worked with most patients, while hospital-based doctors focused on monitoring high-risk patients.

"I could see a patient down the hall and a remote patient and have a better idea of who needs to come to the hospital," said Dr. Bryant.

When involved in telemedicine monitoring, the frequency of visits is based on how patients are faring and their risk for severe illness. Most patients involved in the study received three or four virtual visits, said Dr. Bryant. In addition, the patients could call a nurse triage line anytime with concerns.

The virtual visits with a healthcare provider stopped after patients met CDC criteria for discontinuation of home isolation (10 days after a positive test or first symptom, and no fever for 24 hours).

The program proved effective in preventing hospitalization and, ultimately, protecting hospital resources. Over a three and a half month period, more than 1100 patients enrolled in the home monitoring program and only 6.2% of patients — most of whom were identified as high risk — were hospitalized. About 1.2% required ICU admission.

"It was rewarding to see...a low hospitalization rate as compared to early on in the pandemic as reported elsewhere," Dr. Bryant said. "Most patients also completed the program, which indicates it was something they found helpful."

The Future of Telemedicine

While the telemedicine model worked well for COVID-19 pandemic, Dr. Bryant said it could be used for managing other respiratory infections and chronic conditions such as heart failure and asthma.

For example, healthcare providers could send patients home with or deliver equipment for monitoring oxygen levels or, in the case of heart failure, scales that alert doctors about fluid retention (a sign of heart failure). "It's a good way to monitor people for specific diseases and keep them out of the hospital," said Dr. Bryant.

Dr. Sharma agrees that home monitoring models will likely only increase, even as the pandemic becomes less of an issue, and that patients might increasingly prefer the option to manage their conditions outside of a hospital setting. Many healthcare systems have already implemented similar programs for COVID-19, and some already have programs for patients with chronic illnesses.

"If you can get the same level of care in the comfort of your own home, why would you not take that option?" said Dr. Sharma.

Along with reducing strain on healthcare workers themselves, remotely monitoring mildly or moderately ill patients ultimately frees up in-patient beds in hospitals for patients who are severely ill or require in-person monitoring.

"Every time you admit another person, that's one person who can't get a bed," said Dr. Sharma. "We're starting to realize that rather than building more beds or hospitals, we can remotely monitor patients to address these capacity issues."

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.