The Utility of Telemedicine In Managing Patients After COVID 19

Abstract

1. Introduction: Despite growing knowledge about transmission and relatively wide access to prophylaxis, the world is still facing a severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) global pandemic. Under these circumstances telemedicine emerges as a powerful tool for safe at-home surveillance after a hospital discharge; the data on when to safely release a patient after acute COVID 19 is scarce. Reckoning an urgent need for improving outpatient management and possibly fatal complications of the post-COVID period, we performed the pilot telemonitoring program described below.2. Materials and methods: Patients were involved in the study between December 2020 and May 2021. Recruitment was performed either during the hospital discharge (those hospitalized in a Barlicki Memorial Hospital in Lodz) or first outpatient visit up to 6 weeks after discharge from another center. Every participant received equipment for daily saturation and heart rate measurement coupled with a tablet for remote data transmission. The measurements were made after at least fifteen minutes of rest in a sitting position without oxygen supplementation. Along with the measurements, the cough and dyspnea daily surveys (1 to 5 points) and Fatigue Assessment Scale weekly surveys were filled. We expected a drop of saturation during thromboembolic events, infectious complications, etc.3. Results: A total of 30 patients were monitored for a minimum period of 45 days, at least 2 weeks after spontaneous saturation normalization. Mean age was 55 (mean 55.23; SD +/- 10.64 years). The group was divided according to clinical improvement defined as the ≥10% functional vital capacity (FVC) raise or ≥15% lung transfer for carbon monoxide (TL,CO) rise. Our findings suggest that at-rest home saturation measurements below 94% (p=0.03) correspond with the lack of clinical improvement in post-COVID observation (p=0.03). The non-improvement group presented with lower mean – 94 (93-96) % vs 96 (95-97)%, p=0.01 and minimum saturation – 89 (86-92)% vs. 92 (90-94)%, p=0.04. They also presented higher variations in saturation measurements; saturation amplitude was 9 (7-11)% vs 7 (4-8)%, p=0.03; up to day 22 most of the saturation differences reached statistical significance. Last but not least, we discovered that participants missing 2 or more measurements during the observation were more often ranked into the clinical improvement group (p=0.01). Heart rate day-to-day measurements did not differ between both groups; gathered data about dyspnea and cough intensity did not reach statistical significance either. 4. Conclusions: A better understanding of the disease’s natural history will ultimately lead us to a better understanding of long COVID symptoms and corresponding threats. In this paper, we have found home oxygen saturation telemonitoring to be useful in the prediction of the trajectory of the disease course. Our findings suggest that detection of at-rest home saturation measurement equal to or below 94% corresponds with the lack of clinical improvement in the time of observation and this group of patients presented higher variability of day-to-day oxygen saturation measurements. The determination of which patient should be involved in telemedicine programs after discharge requests further research.