Letter to the Editor: Virtual Care for Critically Ill Patients with COVID-19

Virtual Care for Critically Ill Patients with COVID-19

In a recent article, Omboni et al. suggested that during the COVID-19 epidemic, Italy was unprepared to manage lockdown patients with chronic diseases due to a limited availability of telemedicine solutions. ¹ However, the widespread of infection is associated with a demand to provide adequate care for thousands of hospitalized SARS-CoV-2–infected patients.

SARS-CoV-2 impacted Russia later than Italy and many other countries. The government had time to adopt appropriate measures to mitigate the impact of the emerging outbreak of infection, (i.e., mass testing, contact tracing, mask wearing, self-isolation, and finally a lockdown of the country). Efforts to avoid the worst-case scenario included reprofiling of thousands of hospital beds and rapid construction of new medical facilities for infected patients. More than 110,000 physicians of different specialties and young interns, including those who lacked expertise in treating progressive respiratory failure, joined the battle against COVID-19.

To address a potential lack of skills necessary for effective management of critically ill patients with COVID-19, the Russian Ministry of Health made an investment in telemedicine and set up a Federal Center at the Sechenov University (Moscow) to provide 24/7 virtual support for intensive care unit (ICU) physicians across the country. According to the government's decision, all local COVID-19 hospitals were proposed to submit medical records of critically ill patients through secure network to the Federal Center giving urgent advice on the antiviral therapy and critical care management. The center is operated by a team of faculty members including 5 senior consultants in critical care, pulmonology, infectious diseases, or internal medicine, 8 critical care physicians, 14 pulmonologists, and 4 medical registrars who provide expert assistance (face-to-face if required) to the local physicians at no cost. Since the beginning of the outbreak, we were performing up to 100–150 remote consultations per day, and their total number has now reached 4,500 (Fig. 1). Medical records were received from the hospitals located in 78 geographic regions of the Russian Federation. Preliminary analysis showed that among the first 987 ICU patients with SARS-CoV-2–induced severe pneumonia, 646 (65.6%) died and 341 (34.5%) recovered.

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Fig. 1.

Cumulative number of remote consultations in March–June, 2020.

The COVID-19 outbreak is rapidly removing various legal, regulatory, and reimbursement barriers to telehealth services. ² In the face of the fast-growing spread of SARS-CoV-2 infection, health systems worldwide are adopting virtualized treatment approaches that obviate the need for physical meetings between patients and health care providers. ³ In the United Kingdom, a new National Health System (NHS) 111 online service was established to help people get quick advice about coronavirus, whereas the official NHS website informs that many general practitioners have online services where patients can book a phone or video appointment, order repeat prescriptions, and see test results. Most telehealth initiatives imply patient-oriented approaches to contain the outbreak of COVID-19 and to promote high-quality medical e-care. However, provider-to-provider telemedicine may also be useful both during pandemic and in peacetime, particularly in countries with substantial regional variation in medical care.