In December 2019, an outbreak of 2019-coronavirus (COVID-19) caused a substantial
public health crisis in Wuhan, China, growing into a global pandemic [1]. With a population
of > 100 million, Shandong province is an enormous, economically developed province
with frequent population movement. It is in East China and close to Henan province
(the third largest population in China), South Korea, and Japan. Therefore, preventing
an epidemic was critical in Shandong province.
As of March 26, 2020, 759 confirmed cases, including 71 critically ill patients and
seven deaths, occurred in Shandong Providence, with a reported mortality rate of 0.92%,
which was lower than the national mortality rate of 4.01%. The lower incidence and
death rates potentially indicate the preventive strategies in Shandong providence
were effective. The Shandong provincial government and the Shandong Health Committee
responded quickly to the epidemic and established “Anti-epidemic Expert Group” to
formulate diagnosis, treatment, quarantine, and reporting protocols. In the management
of COVID-19 patients, the expert group comprehensively utilized all professional platforms,
including telemedicine to connect patients, experts, and information. Additionally,
telemedicine provided prevention and treatment guidance, training, communication,
and remote consulting for the community residents and medical staff. The Anti-epidemic
Expert Group found the telemedicine platform to play a considerable role in controlling
the COVID-19 epidemic in the Shandong province (Fig. 1). Here, we describe the experiment
and the benefits of using telemedicine for the prevention of COVID-19.
Fig. 1
Telemedicine platform function
Community residents
Telemedicine platform included a COVID-19 informational page, which updated the latest
information in real time, including instructions for quarantine processes at home,
personal protection applications, and time for seeking medical attention. On January
24, 2019, remote education for vulnerable individuals, including pregnant women, was
initiated. During this epidemic, only one pregnant woman was severely ill in Shandong
province with very favorable outcomes.
The telemedicine platform also included an online consulting clinic, where experts
were available 24 h/day. Experts could conduct preliminary screenings through remote
consultation, which avoided the risk of cross infection in the hospitals and relieved
pressure away from designated hospitals. Community residents and providers felt it
created favorable support for early detection, diagnosis, and prevention.
Patients
Community residents with symptoms could consult through online clinic consultation
services. Experts conducted preliminary screenings of patients online and gave suggestions
to continue to stay home or to go to the hospital. After arrival at the hospital fever
clinic, clinicians determined whether patients were suspected for COVID-19. Following
this initial triage, an expert conducted a remote consultation for further determination
of the risk of COVID-19. Non-severe cases were assessed according to the following
criteria for the severity of latent instances: (1) the National Early Warning Score
(NEWS) score and (2) age > 65 years [2, 3]. These cases were reported to the expert
group via telemedicine every day, thereby implementing early preventive interventions
for this group of patients. For cases with severe illness, remote consultation could
be arranged at any time via telemedicine. Patients discharged from the hospital were
followed up via telemedicine. Telemedicine seamlessly monitored patients from initial
triage through to post-discharge, while also collecting patient data to be incorporated
into a future database (Fig. 2). During the epidemic period, 582 cases were consulted
in Shandong province and 15 in Hubei province. Telemedicine consulting saved time
and cost, while decreasing the risk of infection distribution by avoiding close contacts
with patients with COVID-19.
Fig. 2
COVID-19 patient management protocol by telemedicine
Medical staff
Due to the heterogenous distribution of medical resources across Shandong, the level
of medical treatment availability varied. Many regions do not have intensive care
units (ICU) or adequate ICU medical staff. Additionally, most designated COVID-19
hospitals focus on infectious disease but lack experience in the management of critically
ill patients. Experts in pulmonary and intensive care medicine and infectious diseases
have different experiences and resources with regard to patient management, including
oxygen therapy, intubation timing, and application of therapeutic agents like corticosteroids.
Homogenizing and refining management of COVID-19 patients is vital to improving patient
outcomes.
The Shandong Anti-Epidemic Expert Group utilized the “telemedicine” platform to carry
out epidemic control activities in Shandong and Hubei provinces. Also, Shandong province
supported medical teams, not only in China but also around the globe. On January 23,
2020, telemedicine shared personal protection videos and conducted remote training
for healthcare providers in Shandong province. Concurrently, 50 training and panel
discussions were held nationwide by telemedicine. Expert panels from intensive care,
respiratory, infectious disease, and traditional Chinese medicine backgrounds were
invited to connect with Hubei province colleagues. Topics included diagnosis, respiratory
support, circulation, immunization, extracorporeal membrane oxygenation (ECMO) treatment,
case discussion, personnel protection, psychological counseling, and management of
critically ill patients with COVID-19. More than 500,000 individuals participated
in these video conferences.
The World Health Organization (WHO) recently declared COVID-19 a pandemic. The Shandong
province expert group invited Chinese topic authorities to use the “Cloud ICU” platform
to share their experience managing critically ill patients with COVID-19 to help mitigate
the global spread of COVID-19 using telemedicine. The platform is equipped with an
anti-epidemic diary and telephone hotline to help reduce medical staff burnout, which
has given healthcare providers a chance to communicate with each other, develop a
sense of belonging to the community, and a secure feeling, allowing them to remain
vigilant in fighting this disease.
COVID-19 is an entirely new disease with emerging conflicting information in the media
and internet [4]. This information overload coupled with tremendous patient workload
makes healthcare providers prone to burnout and depression. Telemedicine is a professional
and reliable information platform that delineates factual information, allowing medical
staff to obtain reliable information in real time with appropriate authentication.
Additionally, medical staff can communicate with colleagues, listen to lectures, apply
for consultations, etc. This platform is considered safe, trustworthy, convenient,
and time-, labor-, and cost-saving.
Telemedicine activities avoid close contact and decrease the latent COVID-19 infection
chance; therefore, in this peculiar period, telemedicine plays a huge role. Based
on our positive experience using telemedicine, we suggest establishing similar professional
telemedicine platforms, using remote technologies to integrate resources, share information,
and support healthcare providers. We believe if everyone works together, an ultimate
victory over this pandemic is achievable.