Role of Telehealth in the Management of COVID-19: Lessons Learned from Previous SARS, MERS, and Ebola Outbreaks

The outbreak of coronavirus disease (COVID-19) has become a global health disaster and the World Health Organization (WHO) announced it as a pandemic in March 2020.¹

As of April 15, 2020, >2,012,000 people worldwide have been infected with the virus and >127,000 have died. The United States, Spain, Italy, France, Germany, United Kingdom, China, and Iran are the countries with the highest prevalence.²

Concerns about the disease and its management are increasing. The economic consequences of the coronavirus have affected the whole world and disrupted daily life in many countries. If the outbreak is not managed and controlled as soon as possible, the health systems would face serious difficulties for health staff and shortage of medical equipment.

COVID-19 is a global issue. At present, all symptomatic individuals must be quickly identified and quarantined. In contrast, it is also important in the case of such transmittable epidemics, minimum travel and transfers are done for diagnosis, treatment, and also follow-ups. Mental health problems during such a crisis and rehabilitation issues are also of importance as well. In this situation, it seems that providing diagnostic therapeutic services and following up of patients with COVID-19 with the help of telemedicine can be a good solution.

The benefits of using telehealth technology in epidemics include keeping healthy people away from probably infected centers such as hospitals by remotely screening and also increasing safe access to care for elderly people.³

Telehealth has had a positive impact on a number of epidemic diseases similar to COVID-19 in the past. During the years 2014–2016, when Africa was dealing with the Ebola crisis, there was a challenge of how to interrupt ongoing transmission of the Ebola virus to others. In this situation, an approach was used to combat the disease using a mobile app named Ebola Contact Tracing (ECT), which helped remotely monitor and contact trace confirmed cases of Ebola virus disease. Data gathered by the ECT app were faster, secure, and complete as compared with a paper-based form and it could accurately monitor large number of contacts.⁴

Over the period of outbreak of severe acute respiratory syndrome (SARS) in 2003, teleconsultation in Taiwan was used for patients with SARS. In the study, there was a software that enabled experts in the distance to communicate with patients by using just a computer equipped with a webcam, a microphone, and speakers through the ADSL line between the expert site and local site of the patient. The study illustrated that not only the costs of treatment were reduced due to eliminating the experts’ travels, but also the availability and safety of health staff were increased significantly by using the method.⁵

Another instance of applying telemedicine was teleconsultations due to influenza-related symptoms. One of the largest telemedicine centers in Europe is located in Switzerland. The Swiss Centre for Telemedicine, Medgate, is available 24/7 for all Swiss residents answering all medical problems. The method is simple, during the patient call, the telemedical assistant, after identifying the patient, asks about the patient’s symptoms and medical problems and then registers it for physicians to evaluate and further actions. As a result of the study, teleconsultation made it more useful to identify the early beginnings of an influenza outbreak.⁶

In the current situation, China has been able to control and manage the coronavirus crisis very well by using telehealth. Despite being the main affected country by the COVID-19, China has managed to reduce the number of new cases to <100 per day and the number of deaths to <500, almost since March 2020.²

Providing medical services using virtual clinics has enabled people in China to access the necessary clinical examinations and care without the need to travel. For example, West China Hospital of Sichuan University in collaboration with ZTE and China Telecom one of the largest providers of telecommunications services was able to provide remote medical services using 5G technology.⁷

A health center in China has set a network titled Emergency Telemedicine Consultation System (ETCS) by using 5G technology for response and alert for COVID-19 outbreak with 126 network hospitals within 82 h. During the period January 28–February 17, 2020 among patients who received telemedicine consultations through the designated network, 63 patients had a severe infection while 591 were moderate cases. As of February 17, 2020, the quantity of cured and discharged patients was 420.⁸ Companies offering virtual health care services such as Ali Health (part of Alibaba), JD Health, and WeDoctor offer services to manage patients remotely throughout China.⁷

By observing China’s potential success in using telemedicine technology to stop or slow down the spread of COVID-19, other countries that are also confronting the coronavirus are using information and communications technology (ICT) tools to manage this crisis.

In the United States, virtual health care companies such as Teladoc and AmWell have facilitated communication between physicians and patients through secure video chats.⁹ The government also approved “Coronavirus Preparedness and Response Supplemental Appropriations Act” to support the expansion of the use of telemedicine services. The law provides the possibility of using telephones with “audio and video capabilities” such as smartphones in remote areas for providing health care.⁹

The Australian government has also provided funding for the Medicare telehealth services to combat the coronavirus, encourage providers, and help provide mental health services in the coronavirus crisis. Virtual visits have been expanded to protect health staff and patients against COVID-19 disease and “Medicare support at home” program has also helped to extend telehealth during the coronavirus outbreak for all Australians.¹⁰

In general, the mentioned applications of telecommunications in past and current crises demonstrate the potential of remote teleconsultation in the management of viral epidemics. The important issue is that many developing countries are not ready to take advantage of telehealth, especially for their remote and rural areas despite the significant growth of technology, such as increased penetration of smartphones and the expansion of 3G and 4G internet networks.

Although in the majority of developed countries telemedicine is recognized as routine health care services, in many developing countries there is no legislation and/or rules to support telemedicine. In developing countries, where problems such as population dispersion and lack of health care facilities are more significant than developed countries, it would be difficult to screen people for COVID-19 epidemics without the help of telehealth technology.

Since governments have an important role to play in supporting and funding health care systems to establish telemedicine, regulations and laws need to be legislated as soon as possible to integrate ICT into the conventional health system. We propose that developing countries revise and upgrade technological infrastructures as well as develop laws and guidelines to address relevant legal and ethical barriers to manage this crisis.

Although it is important to equip health centers for technical and communication infrastructure, even in areas where there is no acceptable bandwidth for video calls, health care services such as screening and patient follow-ups can be provided by phone calls. Again, the issue that is more important than technical matters is developing a law for using telemedicine and introducing it into the health care delivery system.

Besides, it is important to understand, from current and previous experience, what are the best applications of telemedicine to screening, diagnosis, treatment, rehabilitation, and follow-up against acute respiratory illnesses.

Funding Information

The authors received no specific funding for this work.