JMIR Publications

Viewpoint: Monitoring quarantined contact individuals and potential COVID-19 patients using telemedicine Michel Bielecki, MD; Patricia Schlagenhauf PhD; Giovanni Andrea Gerardo Crameri, MD; Simon Selden; Thomas Werner Buehrer, MD; Matthieu Komorowski MD PhD Introduction Outbreaks of COVID-19 can lead to widespread quarantine measures affecting millions of people worldwide.1 This poses two distinct challenges to healthcare workers and regulators. Firstly, detecting symptoms in quarantined persons early to minimize the spread of the disease among the quarantined population. Secondly, monitoring symptoms and disease progression in infected individuals to provide adequate escalation of care to those in need of medical attention. Both should be done in a pragmatic way without wasting resources. Short online questionnaires have been shown to be useful to remotely monitor travelers’ health.2 Recently, various efforts have been made to use telemedicine, either as a triage system3 or as an active method to monitor key symptoms in COVID-19 patients4. Many governments have launched contact tracing apps with mixed acceptance5 but with success in terms of identification of infected individuals and contact tracing. However, we are unaware of similar approaches by physicians to follow up on COVID-19 symptoms in their patients using online tools. To the best of our knowledge, a platform for clinicians is missing to create or use simple tools to monitor symptoms in a large cohort of quarantined persons. By using such a tool, clinicians could both monitor their COVID-19 patients’ disease progression, thus potentially reducing unnecessary complications and mortality, and the respective quarantined contact persons to limit the spread of the disease. In this piece, we present how we used this method successfully in three different scenarios. We draw attention to the possibility of using existing cloud-based platforms to create telemedicine forms evaluating symptoms and well-being daily. Decision-making based on algorithms that were put together with simple criteria can be useful when decision-makers face psychological challenges or have a large number of patients. Rather than trying to showcase or validate our tool, we want to encourage healthcare providers to innovate when they find themselves in similar situations. Presentation of Online Tool We designed an online self-assessment using the questionnaire platform Typeform, which respects data security and protection adequately. It focuses on three aspects: The patient’s current well-being, any change compared to the previous day, and common COVID-19 symptoms (Figure 1).6,7 This simple, three-step survey is designed to be easily completable in little time by almost anyone. Patients receive the link to the questionnaire by email or via a printed out QR-Code and are asked to fill out the form once a day. The healthcare worker in charge can check the Typeform website once daily as well, immediately seeing if any patient’s state has changed. This enables the physician to contact only those in need and give the patients a sense of security while sparing both parties unnecessary time-consuming phone calls Our Experience with this Approach We established such a procedure in three different scenarios: At a Swiss Armed Force’s base that had a large number of SARS-CoV-2 positive cases, abroad for Swiss personnel stationed in Kosovo involved in peacekeeping operations, and one general practice in Switzerland For the first two scenarios, quarantined personnel were required to complete the digital self-assessment form every day, and the results were checked daily by medical staff. Patients who self-reported a change in their constitution or who became symptomatic were picked from the cohort for oronasopharyngeal swabbing and subsequent RT-qPCR. In both cohorts, we were able to pick out and isolate new symptomatic patients early on with this method. The same questionnaire is currently being trialed by a general practitioner in Wengen, a Ski resort in which various super-spreader events occurred throughout the winter of 2020/2021. In such places, large cohorts of people are being supervised by a single doctor and it is difficult to keep track of new infections. The report on that trial will be published in a follow-up paper. We encourage physicians and medical staff worldwide to use simple digital tools such as self-made reporting forms to monitor their patients and contact persons remotely with a telemedicine approach. Such an approach might prove especially useful in a General Practice setting with many subcohorts of COVID-19 contact persons. For further studies, it might be interesting to explore and test further possible settings for this approach, given its ease of use and modifiable nature. The questionnaire could further be adapted to monitor other types of diseases in outpatient settings. REFERENCES 1. Rudan I. Answering the initial 20 questions on COVID-19. Available from: http://dx.doi.org/10.7189/jogh.10.010106 2. Farnham A, Röösli M, Blanke U, Stone E, Hatz C, Puhan MA. Streaming data from a smartphone application: A new approach to mapping health during travel. Travel Med Infect Dis 2018;21:36–42. 3. Hollander JE, Carr BG. Virtually Perfect? Telemedicine for Covid-19. N Engl J Med 2020;382(18):1679–81. 4. Xu H, Huang S, Qiu C, et al. Monitoring and Management of Home-Quarantined Patients With COVID-19 Using a WeChat-Based Telemedicine System: Retrospective Cohort Study. J Med Internet Res 2020;22(7):e19514. 5. Blom AG, Wenz A, Cornesse C, et al. Barriers to the Large-Scale Adoption of a COVID-19 Contact Tracing App in Germany: Survey Study. J Med Internet Res 2021;23(3):e23362. 6. Bolay H, Gül A, Baykan B. COVID-19 is a Real Headache! Headache 2020;60(7):1415–21. 7. Kim G-U, Kim M-J, Ra SH, et al. Clinical characteristics of asymptomatic and symptomatic patients with mild COVID-19. Clin Microbiol Infect 2020;26(7):948.e1–948.e3.