Document Type : Letter to the editor

Authors

1 Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada

2 Telepsychiatry Research and Innovation Network, Dhaka, Bangladesh

Abstract

Dear Editor,
 
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the third coronavirus to emerge in the past decade after the 2010 SARS-CoV and 2012 MERS-CoV, which originated in China and Saudi Arabia, respectively. The virus is transmitted via small droplets which are produced during activities such as coughing, sneezing, and talking and spread through close human contact or touching infected surfaces. Since its first reported case in Wuhan, China in December 2020, the virus has proved to be highly infectious, reaching epidemic levels with about 2.8 million COVID-19 cases recorded globally. As a result, the World Health Organization was prompted to declare it as a public health emergency of international concern.
 
The virus is of unknown aetiology and has no clinical countermeasures to date; therefore, prevention is the best strategy to prevent its spread. Many countries have enforced physical distancing, banned public gathering, and restricted mobility and transportation options. However, such preventive measures have side-effects which negatively impact healthcare and population health at various levels. Physicians and nurses treating COVID-19 patients are often required to be isolated from their family. Further, clinicians who are not well-versed in the complexities and risks of infectious diseases are facing new challenges. Patients requiring regular or urgent care (e.g., expectant mothers and patients awaiting elective/ emergency surgery) are experiencing limited access to care. Telehealth can ameliorate some of these side-effects and improve healthcare access along with the quality of life for both patients and practitioners.
 
Telehealth for Curbing the COVID-19 Pandemic
 
Lockdowns and stay-at-home orders limited opportunities for referring to health centres, leading to undiagnosed COVID-19 cases which increases the risk of transmission. For patients with relatively minor conditions which resemble COVID-19 symptoms, the fear of being a source of cross-contamination leads to the self-isolation and reduced uptake of needed healthcare services. Telehealth via user-friendly video chat with health professionals can significantly enhance the diagnostic capacity of healthcare system without an increasing flow at health centres and the associated risk of cross-contamination. Primary assessment algorithms, based on age, symptoms, and comorbid conditions, can also be provided via telehealth to determine whether an in-person medical visit is warranted.
 
Telehealth platforms can also facilitate knowledge sharing and awareness building about COVID-19 risks and prevention. For example, in Singapore, some companies have used chat-bots to share COVID-19 updates and to inform employees of the available help. Telehealth technologies can also be used for training of volunteers and new professionals to address healthcare staffing shortages and for disseminating accurate and timely data to health administrators and policy makers so as to assist them in choosing appropriate responses. Online recording and storage of health-related data can accelerate efforts to understand risk factors, to reach evidence-based interventions, and to fill in the research infrastructure gaps in limited-resource countries so that their researchers, clinicians, patients, and healthcare administrators can find appropriate solutions for advanced research and decision-making.
 
In the context of COVID-19 and beyond, telehealth can add digital infrastructure to tackle pandemics, disastrous events, and post-disaster conditions, as corroborated by experts in other fields (e.g., North Atlantic Treaty Organization Multinational System).
 
Telehealth for Mental Healthcare Services During the Pandemic
 
The socioeconomic impact of COVID-19 (i.e., loss of employment, property foreclosures, and bankruptcies at unprecedented rates) is triggering a mental health crisis as evidenced by a significant increase in depression, sleeplessness, self-harm, suicide, as well as alcohol sales. Further, the fear of being infected or infecting others has been reported as the cause of several suicide cases. The increased suicide rate during the previous SARS-CoV outbreak, due to loneliness and disconnectedness, especially among the elderly, reminds us that supporting the population’s psychosocial wellbeing during the pandemic is as critical as fighting the virus itself.
 
Telepsychiatry, a subclass of telehealth, is a validated method to screen for suicidal dispositions and to provide remote emergency mental healthcare in order to reduce suicide rates. Telemedicine experts can also collect data at physiological distress levels (e.g., the fear of COVID-19 scale) to identify populations at risk of self-harm.
 
Psychiatric patients, especially substance abuse patients who are highly stigmatized and marginalized in terms of accessing healthcare services, face a higher risk of decompensation and addiction relapse as self-quarantine restricts therapy attendance. However, several web-based and smartphone applications already offer drug rehabilitation and withdrawal management services to improve outcomes for substance abuse patients worldwide, confirming that digital health innovations can serve the mental health needs of physically and socially isolated populations.
 
Conclusion
 
The COVID-19 pandemic has challenged practitioners in all fields and overwhelmed even the most advanced healthcare systems. Physical and social distancing requirements have also contributed to the reduced healthcare access, especially for mental health patients whose needs are overshadowed by the public health need to control the spread of the virus. In conclusion, since the COVID-19 crisis was proven to be extremely challenging, telehealth has emerged as a silver lining, which we hope will advance to become a mainstream health service and a standard component of effective public health responses.

Keywords

  1. Sharif-Yakan A, Kanj SS. Emergence of MERS-CoV in the Middle East: origins, transmission, treatment, and perspectives. PLoS Pathog. 2014;10(12):e1004457. doi: 10.1371/journal. ppat.1004457.
  2. Al-Osail AM, Al-Wazzah MJ. The history and epidemiology of Middle East respiratory syndrome corona virus. Multidiscip Respir Med. 2017;12:20. doi: 10.1186/s40248-017-0101-8.
  3. Dhand R, Li J. Coughs and sneezes: their role in transmission of respiratory viral infections, including SARS-CoV-2. Am J Respir Crit Care Med. 2020;202(5):651-9. doi: 10.1164/ rccm.202004-1263PP.
  4. Lewnard JA, Lo NC. Scientific and ethical basis for social-distancing interventions against COVID-19. Lancet Infect Dis. 2020;20(6):631-3. doi: 10.1016/s1473-3099(20)30190-0.
  5. Fernandez R, Lord H, Halcomb E, Moxham L, Middleton R, Alananzeh I, et al. Implications for COVID-19: a systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic. Int J Nurs Stud. 2020;111:103637. doi: 10.1016/j.ijnurstu.2020.103637.
  6. Stahel PF. How to risk-stratify elective surgery during the COVID-19 pandemic? Patient Saf Surg. 2020;14:8. doi: 10.1186/s13037-020-00235-9.
  7. De Vos J. The effect of COVID-19 and subsequent social distancing on travel behavior. Transp Res Interdiscip Perspect. 2020;5:100121. doi: 10.1016/j.trip.2020.100121.
  8. Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health. 2020;20(1):1193. doi: 10.1186/ s12889-020-09301-4.
  9. Singapore government launches COVID-19 chatbot. OpenGov Asia website. Available from: https://www.opengovasia.com/ singapore-government-launches-covid-19-chatbot/. 2020.
  10. Pickell Z, Gu K, Williams AM. Virtual volunteers: the importance of restructuring medical volunteering during the COVID-19 pandemic. Med Humanit. 2020;46(4):537-40. doi: 10.1136/medhum-2020-011956.
  11. Bhaskar S, Bradley S, Chattu VK, Adisesh A, Nurtazina A, Kyrykbayeva S, et al. Telemedicine across the globe-position paper from the COVID-19 pandemic health system resilience PROGRAM (REPROGRAM) international consortium (Part 1). Front Public Health. 2020;8:556720. doi: 10.3389/ fpubh.2020.556720.
  12. Doarn CR, Latifi R, Poropatich RK, Sokolovich N, Kosiak D, Hostiuc F, et al. Development and validation of telemedicine for disaster response: the North Atlantic treaty organization multinational system. Telemed J E Health. 2018;24(9):657-68. doi: 10.1089/tmj.2017.0237.
  13. Hu M, Sugimoto M, Hargrave AR, Nohara Y, Moriyama M, Ahmed A, et al. Mobile healthcare system for health checkups and telemedicine in post-disaster situations. Stud Health Technol Inform. 2015;216:79-83.
  14. Steinbuch Y. Italian Nurse with Coronavirus Kills Herself Over Fear of Infecting Others. New York Post; 2020.
  15. Somoynews TV. Available from: https://www.somoynews.tv.
  16. Cheung YT, Chau PH, Yip PS. A revisit on older adults suicides and Severe Acute Respiratory Syndrome (SARS) epidemic in Hong Kong. Int J Geriatr Psychiatry. 2008;23(12):1231-8. doi: 10.1002/gps.2056.
  17. Lee A, Sikka N, O’Connell F, Dyer A, Boniface K, Betz J. Telepsychiatric assessment of a mariner expressing suicidal ideation. Int Marit Health. 2015;66(1):49-51. doi: 10.5603/ imh.2015.0012.
  18. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The fear of COVID-19 scale: development and initial validation. Int J Ment Health Addict. 2020:1-9. doi: 10.1007/ s11469-020-00270-8.