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      Telemedicine Across the Globe-Position Paper From the COVID-19 Pandemic Health System Resilience PROGRAM (REPROGRAM) International Consortium (Part 1)

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          Coronavirus disease 2019 (COVID-19) has accelerated the adoption of telemedicine globally. The current consortium critically examines the telemedicine frameworks, identifies gaps in its implementation and investigates the changes in telemedicine framework/s during COVID-19 across the globe. Streamlining of global public health preparedness framework that is interoperable and allow for collaboration and sharing of resources, in which telemedicine is an integral part of the public health response during outbreaks such as COVID-19, should be pursued. With adequate reinforcement, telemedicine has the potential to act as the “safety-net” of our public health response to an outbreak. Our focus on telemedicine must shift to the developing and under-developing nations, which carry a disproportionate burden of vulnerable communities who are at risk due to COVID-19.

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          COVID-19 and Italy: what next?

          Summary The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already taken on pandemic proportions, affecting over 100 countries in a matter of weeks. A global response to prepare health systems worldwide is imperative. Although containment measures in China have reduced new cases by more than 90%, this reduction is not the case elsewhere, and Italy has been particularly affected. There is now grave concern regarding the Italian national health system's capacity to effectively respond to the needs of patients who are infected and require intensive care for SARS-CoV-2 pneumonia. The percentage of patients in intensive care reported daily in Italy between March 1 and March 11, 2020, has consistently been between 9% and 11% of patients who are actively infected. The number of patients infected since Feb 21 in Italy closely follows an exponential trend. If this trend continues for 1 more week, there will be 30 000 infected patients. Intensive care units will then be at maximum capacity; up to 4000 hospital beds will be needed by mid-April, 2020. Our analysis might help political leaders and health authorities to allocate enough resources, including personnel, beds, and intensive care facilities, to manage the situation in the next few days and weeks. If the Italian outbreak follows a similar trend as in Hubei province, China, the number of newly infected patients could start to decrease within 3–4 days, departing from the exponential trend. However, this cannot currently be predicted because of differences between social distancing measures and the capacity to quickly build dedicated facilities in China.
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            Medical Student Education in the Time of COVID-19

             Suzanne Rose (2020)
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              Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action

              On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) outbreak as a pandemic, with over 720,000 cases reported in more than 203 countries as of 31 March. The response strategy included early diagnosis, patient isolation, symptomatic monitoring of contacts as well as suspected and confirmed cases, and public health quarantine. In this context, telemedicine, particularly video consultations, has been promoted and scaled up to reduce the risk of transmission, especially in the United Kingdom and the United States of America. Based on a literature review, the first conceptual framework for telemedicine implementation during outbreaks was published in 2015. An updated framework for telemedicine in the COVID-19 pandemic has been defined. This framework could be applied at a large scale to improve the national public health response. Most countries, however, lack a regulatory framework to authorize, integrate, and reimburse telemedicine services, including in emergency and outbreak situations. In this context, Italy does not include telemedicine in the essential levels of care granted to all citizens within the National Health Service, while France authorized, reimbursed, and actively promoted the use of telemedicine. Several challenges remain for the global use and integration of telemedicine into the public health response to COVID-19 and future outbreaks. All stakeholders are encouraged to address the challenges and collaborate to promote the safe and evidence-based use of telemedicine during the current pandemic and future outbreaks. For countries without integrated telemedicine in their national health care system, the COVID-19 pandemic is a call to adopt the necessary regulatory frameworks for supporting wide adoption of telemedicine.

                Author and article information

                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                16 October 2020
                16 October 2020
                : 8
                1Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee , Sydney, NSW, Australia
                2Department of Neurology, Liverpool Hospital and South Western Sydney Local Health District , Sydney, NSW, Australia
                3Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, The University of New South Wales, UNSW Medicine , Sydney, NSW, Australia
                4The University of New South Wales (UNSW) Medicine Sydney, South West Sydney Clinical School , Sydney, NSW, Australia
                5Department of Medicine, University of Toronto, St. Michael's Hospital , Toronto, ON, Canada
                6Department of Epidemiology and Biostatistics, Semey Medical University , Semey, Kazakhstan
                7The University of the West Indies , St. Augustine, Trinidad and Tobago
                8School of International Development and Global Studies, University of Ottawa , Ottawa, ON, Canada
                9Department of Public Health, University of Tennessee, Knoxville, Knoxville , TN, United States
                10Department of Neurology, University Hospitals Birmingham NHS Foundation Trust , Birmingham, United Kingdom
                11School of Science, Western Sydney University , Sydney, NSW, Australia
                12Global Brain Health Institute, Trinity College Dublin , Dublin, Ireland
                13Movement Disorders Institute, Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan & Sackler School of Medicine, Tel Aviv University , Tel Aviv, Israel
                14metaHealth Insights and Innovation , Manila, Philippines
                15Department of Anthropology, University of Delhi , New Delhi, India
                16University of Alberta, Alberta Health Services and Project PoSSUM , Edmonton, AB, Canada
                17Penn Medicine Lancaster General Hospital and Project PoSSUM , Lancaster, PA, United States
                18Icahn School of Medicine, Mount Sinai Hospital, Mount Sinai , New York, NY, United States
                19Polish Mother's Memorial Hospital Research Institute (PMMHRI) in Lodz, Cardiovascular Research Centre, University of Zielona Gora , Zielona Gora, Poland
                20Department of Hypertension, Medical University of Lodz , Lodz, Poland
                21Farr Institute of Health Informatics, University College London (UCL) & NHS Foundation Trust , Birmingham, United Kingdom
                Author notes

                Edited by: Alberto Eugenio Tozzi, Bambino Gesù Children Hospital (IRCCS), Italy

                Reviewed by: Caterina Rizzo, Bambino Gesù Children Hospital (IRCCS), Italy; Laszlo Balkanyi, University of Pannonia, Hungary

                *Correspondence: Sonu Bhaskar Sonu.Bhaskar@

                This article was submitted to Digital Public Health, a section of the journal Frontiers in Public Health

                Copyright © 2020 Bhaskar, Bradley, Chattu, Adisesh, Nurtazina, Kyrykbayeva, Sakhamuri, Yaya, Sunil, Thomas, Mucci, Moguilner, Israel-Korn, Alacapa, Mishra, Pandya, Schroeder, Atreja, Banach and Ray.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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                Figures: 1, Tables: 1, Equations: 0, References: 116, Pages: 15, Words: 11778
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