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?:abstract
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BACKGROUND: Most coronavirus disease 2019 (COVID-19) patients with mild symptoms were sent home for recovery. However, some of them developed severe or critical conditions as the disease progressed. OBJECTIVE: To develop a telemedicine model to balance the challenge of treating progressive COVID-19 patients who are home-quarantined and shortages in the medical workforce. METHODS: A telemedicine system was developed to continuously monitor the progression of home quarantined COVID-19 patients. The system was built on a popular social media smartphone app called WeChat, which established two-way communication between a multi-disciplinary team consisting of seven medical workers and 188 home-quarantined individuals (including 74 confirmed COVID-19 patients). The system helped patients self-assess their conditions and update the multi-disciplinary team through a telemedicine form stored on a cloud service, based on which the team made treatment decisions accordingly. RESULTS: Out of 188 individuals using the telemedicine system, 114 individuals did not infect with COVID-19 and were dismissed. 26 confirmed COVID-19 patients recovered during the study period, and voluntarily quit the system. The remaining 48 confirmed COVID-19 patients used the system until the end of the study, including six patients who progressed to a severe or critical condition. These six patients were admitted to hospital and were saved (one received ECMO support for 17 days). All 74 COVID-19 patients eventually recovered. Through the comparison of monitored symptoms between hospitalized and non-hospitalized patients, this study found the prolonged persistence and deterioration of fever, dyspnea, lack of strength, and muscle soreness to be diagnostic for identifying patients for hospitalization. CONCLUSIONS: By continuously monitoring the changes of several key symptoms, the telemedicine system reduces the risks of delayed hospitalization for COVID-19 patients quarantined at home due to disease progression. The system uses a set of scales of quarantine management assessment for patients to self-assess their conditions. The results are useful for medical staff to identify disease progression, and hence, make appropriate and timely treatment decisions. The system requires little manpower to handle a large cohort of patients. In addition, the system can solicit help from the recovered but self-quarantined medical workers to alleviate the shortage in the medical workforce, and free healthy medical workers to fight frontline. Thus, it optimized the usage of local medical resources and prevented cross-infections among medical workers and patients.
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