The 2019 novel coronavirus has destroyed lives, debilitated communities, and damaged economies around the globe. It is an existential threat that requires us to work together across national borders and continental divides to develop a common solution. Our science, technology, and infrastructure have never been more advanced — the key question is whether our governments can mobilize rapidly and coordinate effectively to contain this outbreak.
I have devoted a major part of my time over the past decade to designing, building and deploying next-generation technologies to empower large-scale clinical operations at leading health plans. Today, these solutions support medical management for millions of people enrolled in Medicare and Medicaid programs. Through this work, I have gained a valuable perspective, along with an appreciation of how population-level strategies are only as good as their translation into point of care delivery by frontline healthcare professionals.
The key to a viral outbreak is to identify and quarantine infected individuals before they can spread the virus to others. It is a harrowing race against the exponential nature of the infection, where each sick person can infect ten, every ten can infect a hundred, every hundred can infect a thousand, and so forth. By quarantining the hosts until their infections have passed, we take the virus out of circulation. The key goals are to identify infected individuals and to address their treatment and quality of life needs without them needing to leave their homes.
Hospitals are not a solution to a challenge of this magnitude: even developed countries lack the beds and the staff to address an inflow of patients at true pandemic levels. Moreover, overcrowded hospitals only exacerbate the problem, creating hotbeds of infection and fomenting viral super strains that are both lethal and immune to intervention. Thus, with viral infections, the best chance of containment is to keep infected individuals separated from both each other and the community. Implementing an effective home-based detection and quarantine regime requires what I have termed the five tenets: training, testing, telehealth, transport, and technology.
The first tenet is training the population about the nature of the coronavirus disease, including prevalence, prevention, and symptoms. To date, the world’s health organizations and the media have done a remarkable job of raising awareness and educating the populace about COVID-19. Thanks to the internet, the spread of information has outpaced the spread of the virus and this has proven to be a crucial weapon in our fight against the disease.
The second tenet is testing individuals who are at risk, either because they have been exposed to known carriers or locations, or because they are exhibiting symptoms. To accomplish this, world governments must coordinate closely with pharmaceutical manufacturers and laboratories on the mass production of rapid testing kits, not only for professional healthcare use but for self-administration by patients inside the home.
Broadly, there are two flavors of testing: mandatory and voluntary. All travelers from high-risk areas should undergo mandatory testing at ports of entry prior to being released into the community. At the same time, voluntary testing must be accessible to the general population to make it easy for individuals to determine if they have the virus. Accomplishing this requires setting up testing centers at all key ports of entry and in all major cities with appropriate facilities, trained healthcare workers, aseptic techniques, and a ready supply of rapid testing kits. Governments can work with private sector distribution channels — the likes of Amazon, CVS, and Alibaba — to make rapid testing kits available for home delivery. The government would cover the cost, but to order such a kit, the individual would have to answer a health risk screening questionnaire specifically designed to identify coronavirus related risk factors. Beyond the obvious benefit of empowering people to self-diagnose, such an approach would enable governments to collect critical health information and more accurately track the spread of the virus.
The third tenet is telehealth, meaning the provision of healthcare services via videoconferencing technologies and connected devices. A physician can examine a patient via video visit and, outside of testing and diagnostics, often arrive at the same conclusion as an in-person visit. However, a video visit allows the patient to remain at home. This means that a patient with COVID-19 would not have the opportunity to infect contemporaneous travelers, other patients, or the physician’s staff. Telehealth services, available in the United States and many other countries, are increasingly covered by medical insurance. The challenge is that most people still associate “going to the doctor” with literally going to the doctor and telehealth has not received the attention it requires in the wake of the coronavirus outbreak.
Governments have an opportunity to set up telehealth “hotlines” that allow individuals with suspected or confirmed coronavirus to receive real-time medical attention from a trained doctor or nurse practitioner. As with at-home rapid testing kits, a health risk screening questionnaire can be used as part of the visit request. During the video visit, the medical professional would be able to assess and educate the patient, develop a treatment plan, and prescribe medications. For suspected cases, a self-test kit can be sent to the patient’s home or the patient can be directed to a local testing center.
The fourth tenet is transport, meaning the delivery of required products and services to the patient’s home. Most of us are fortunate to live in countries where e-commerce has resulted in robust distribution networks that make it possible to order anything from groceries to furniture online and have it delivered to our doorstep. That means many locations have the infrastructure in place not only to deliver self-test kits and prescribed medications, but also the food, beverages, toiletries, and consumables for someone to live in relative comfort during a period of self-quarantine.
If a patient becomes progressively sicker, a physician can determine the need to hospitalize during a telehealth visit and dispatch an ambulance to bring the patient to the hospital in a manner that minimizes risk of infection to the surrounding community. Alternatively, a healthcare worker using the appropriate aseptic technique and bringing the necessary equipment can visit such a patient in the home to deliver the required level of care when it exceeds the patient’s self-service abilities.
As the fifth and final tenet, governments must deploy a central information management capability to collect patient data, establish awareness communications, record telehealth visits, manage care plans, and track health outcomes. To this end, enterprise medical management solutions such as VirtualHealth’s HELIOS platform provide a ready-made tool for precisely this type of large-scale data aggregation, integration, and workflow management across the care continuum — from providers entering treatment information for individual patients to government administrators seeing population-level trends in real-time.
In this context, the technology component ensures the other pieces, including training, testing, telehealth, and transport are being appropriately coordinated, managed, and monitored. Automated workflows supported by these systems ensure that causal events, such as a confirmed coronavirus diagnosis, automatically trigger the appropriate intervention, such as telephonic outreach by a healthcare worker to schedule a video visit. At the same time, standardized forms ensure that data related to each step — from health risk screening to test result to virtual visit to care plan to outcome — is recorded in a standard manner that supports population-level trending, analysis, and intelligence.
The five tenets represent a comprehensive approach to combating the coronavirus outbreak and must be deployed in concert to ensure success: the population must be trained on preventive measures, testing must be made broadly available, patients who test positive must have access to telehealth and transport to support self-quarantine, and government agencies and healthcare organizations must be able to monitor all facets of response via integrated technologies. Governments that mobilize quickly and deploy the five-pronged strategy will maximize their chance of success in protecting the communities under their watch.