Most COVID-19 Patients Can Be Managed Remotely

By Reuters Staff

April 02, 2020

NEW YORK (Reuters Health) - Most patients with COVID-19 infection can be managed by phone or video chat, according to a new report providing step-by-step guidance on remote consultations.

"At the time of writing, the situation is changing rapidly. This article will be updated as new evidence emerges. National and local protocols are likely to emerge for the topics covered in this article and other aspects of care in covid-19," Dr. Trisha Greenhalgh of the University of Oxford in the UK and colleagues write in The BMJ.

Telephone management is adequate for patients with mild symptoms and uncomplicated infections, the authors note.

"Video may be appropriate for sicker patients, those with comorbidities, those whose social circumstances have a bearing on the illness, and those who are very anxious," they add. "Patients who are hard of hearing may prefer video to telephone."

All patients need safety-net advice, given that respiratory function can deteriorate quickly, particularly during the second week of infection, according to the authors.

Fever in patients with COVID-10 can exceed 38 C, the authors note, and last for longer than five days, although as many as half of infected patients have no fever at presentation.

Symptoms that are not indicative of COVID-19 infection include nasal congestion and allergy-like symptoms, the authors note. Patients with seasonal flu are more likely to have body aches, while shortness of breath is a hallmark of COVID-19. Diarrhea and other gastrointestinal symptoms may also be present, and infected patients also report loss of appetite and anosmia.

Urgent assessment in person or on video is needed for patients with "severe breathlessness or difficulty breathing, pain or pressure in the chest, blue lips or face, and a story suggestive of shock (such as cold and clammy with mottled skin, new confusion, becoming difficult to rouse, or significantly reduced urine output)," the authors add.

While there are no validated tools available for assessing breathlessness remotely in the acute primary care setting, Dr. Greenhalgh and her team provide consensus advice from a survey of 50 healthcare providers with experience in phone assessment.

"There is no evidence that attempts to measure a patient's respiratory rate over the phone would give an accurate reading, and experts do not use such tests," they note. "It is possible, however, to measure the respiratory rate via a good video connection. More generally, video may allow a more detailed assessment and prevent the need for an in-person visit."

SOURCE: The BMJ, online March 25, 2020.