TELEMEDICINE and the 2019 Novel Coronavirus
A decade removed from the last pandemic –Novel H1N1 Influenza in 2008-9, which resurfaced again in 2013 — the world is bracing for the next potential global viral outbreak with the emergence of the novel 2019-nCoV Coronavirus. The virus was first identified and isolated in respiratory illnesses in Wuhan City, Hubei Province, China in December 2019, and in two months has already infected over 6,000 individuals worldwide.
Thankfully, the global spread to date has been relatively small, only a handful of confirmed cases in the United States. But the concern for rapid global spread is nonetheless in the air (pun fully intended).
Read on for more valuable information about the Coronavirus and opportunities for telemedicine to play a critical role in US domestic and worldwide efforts to combat the spread of disease.
What factors contribute to a global pandemic?
In short, it amounts to two major considerations: Disease Spread and Disease Severity. A disease that can be easily transmitted and is particularly virulent can cause worldwide disaster. Conversely, a disease which cannot be easily communicated to others, or one which, even if easily transmitted, has a relatively benign clinical course (like the common cold ) is not of great concern to the global medical community.
What are coronaviruses?
Coronaviruses are a family of viruses which are well known and have been studied since the 1930’s. While most are benign, such as the common cold, particular mutations can cause an uptake in the virulence of the microorganism, leading to outbreaks of severe disease states. This includes Severe Acute Respiratory Syndrome (SARS), which was responsible for over 700 deaths, predominantly in Asia in 2003; and Middle Eastern Respiratory Syndrome (MERS). The novel 2019 nCoV is this type of virus.
What do we know about this most recent virus strain?
First isolated from a patient with respiratory illness in in Wuhan City, Hubei Province, China, it has since been identified in thousands of patients in China with over 150 confirmed deaths and has spread to over a dozen other countries, including the United States.
With the virulence associated to this particular virus strand in the context of the global interconnected world in which we live, experts are justifiably concerned for wide and rapid spread of the infection. Such a spread could prove catastrophic.
Combatting the Spread of this Virus
Thankfully, infectious disease specialists, public health experts, physicians and public policy leaders have stepped in to take meaningful, aggressive measures to combat the spread of the virus. Chinese leaders have quarantined city inhabitants, closed local shops (reportedly Starbucks has shut down many of its local branches) and instituted regulations on mask wearing, hand hygiene and close monitoring for anyone at risk of contracting the illness.
Many countries have either limited flights or travel to China or stopped it entirely. The United States has similarly quarantined a large number of at-risk targets, ceased flights to China and issued a strict travel advisory. I just returned from a trip to California and can attest to the near ubiquitous presence of masks and hand sanitizers and wipes in airports and on airlines.
The Critical Role of Telemedicine
Telemedicine is poised to play a crucial role in the management of this potential global health hazard.
Although the initial signs and symptoms of the infection cannot be easily distinguished from other more benign coronavirus, or other viral, such as influenza infections, and the syndrome cannot be diagnosed without molecular diagnostics, there are a number of important roles that telemedicine physicians can play.
First and foremost, physicians must counsel patients who may need to travel to the region on the risks that such an endeavor would entail. Patients must be made aware as to the scientific realities on the ground. Additionally, those who were in the regions in question, or who were potentially exposed, must be instructed on the proper means – barrier, anti-septic, quarantine, etc. – to prevent exposing others.
Moreover, patients with possible exposure who are experiencing symptoms must be coached to seek medical attention immediately, alert those who they may have inadvertently spread the illness to and direct their medical teams to rule out the novel virus via specific diagnostic evaluation.
Lastly, telemedicine may prove to be a useful area of health information regarding the spread of the infection, identifying new areas of infection and serving as a helpful means of containment. What better clinical service to coordinate and quarantine a disease then a national centralized physician network whose expertise is remote communications and cloud-based software reporting?
It is our sincere hope that current measures help stem the tide of infection spread and prevent worldwide viral dissemination. Telemedicine stands to play a crucial role both in the continued management and isolation of the virus, as well as in coordinating care should it emerge in small pockets in other international domains.
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