Home Is Where the Doctor Is

If COVID-19, the respiratory illness caused by the novel coronavirus that began blazing its way around the planet in late 2019, has taught us anything, it is that some of the most effective tools in fighting a pandemic, while simple, never really change. We must go back to the 1918 “Spanish Flu,” an unusually deadly form of influenza caused by an H1N1 virus that infected more than 500 million people, or about a third of the world’s population, to find a comparable situation to the one we face today. The best estimate of the number of people, mostly young and previously healthy, who died as a result of the 1918 pandemic is around 50 million, with 675,000 deaths occurring in the United States.

Then, like now, people realized fairly quickly that stopping the spread of the virus was the most immediate and important way to fight it. And the easiest way to accomplish that piece of personal self-defense was to stay home and avoid other people so as not to be infected or to spread the infection if you, yourself, had contracted it.

Fast forward to 2020 and, in the face of another infectious virus, we are all (or at least we should be) staying home and flattening our curve—defined as preventing the new cases of COVID-19 from occurring rapidly enough to overwhelm the number of available hospital beds, life-saving ventilators, and the personal protective equipment (PPE) that healthcare workers need to keep themselves healthy and on the job caring for the rest of us.

But staying home is not only a way for healthy people to contribute to stopping the spread of this aggressive new pathogen. It is also an important precaution for those of us who have been diagnosed as having been infected with the virus and are currently experiencing its most commonly reported symptoms of fever, cough, body aches, and shortness of breath. In the vast majority of cases, the physical impact of COVID-19 is “mild to moderate.” But according to the Centers for Disease Control (CDC), an estimated 21% to 31% of COVID-19 patients in the U.S. between Feb. 12 and March 16 were hospitalized, with 5% to 12% being admitted to an intensive care unit.

Knowing when a patient has progressed from a less severe case to one that requires more intense care is crucial, and thanks to a collaborative effort of several UT Health Austin clinicians and a Seattle software company, monitoring patients just got safer and more efficient.

“Because of the obvious benefits of keeping a close watch on the symptoms patients are experiencing in a way that allows those patients to stay in their homes, our team was very interested in developing an electronic platform that would be easy for patients to use,” says Elizabeth Jacobs, MD, Chief of Primary Care and Associate Chair for Research in the Department of Internal Medicine at the Dell Medical School.

“During one of our discussions, Aaron Miri, our Chief Information Officer, mentioned that he knew of an organization in Washington state that was actually working on this same idea. The people at Sentinel Healthcare saw what was happening in the Seattle area, and they decided to pivot the technology platform they had originally created for stroke patients to monitor blood pressure and oxygenation at home to tracking people with COVID-19. We started working with them immediately, and now the system is up and running and we are monitoring a growing population of patients.”

As a general internist, Dr. Jacobs has spent decades providing care in Safety Net organizations. She focuses on addressing health disparities, figuring out ways to deliver important services like cancer screenings to vulnerable groups, and communicating effectively with populations in their own language. She is also an accomplished researcher, which means that she is trained to see problems from a health management perspective, so she knows that tracking COVID-19 symptoms from home was only one part of the challenge that technology might help address. The other is called “contact tracking,” and it is an important tool clinicians use to contain the spread of disease in a community. Our contact tracing efforts are being led by Dell Medical School epidemiologist, Darlene Bhavnani, PhD, and infectious disease specialist, Parker Hudson, MD.

“Once we confirm that someone has COVID-19,” she explains, “the next step is to identify people who have had close contact with that person to see if they are having symptoms too. Even if they are not, we let them know that they should stay home, and use the UT Health Austin Home Health Monitoring service, for 14 days. Since we know that there are people who can spread the illness without experiencing symptoms themselves, keeping people at home who have a high potential of transmitting COVID-19 is a key benefit of contact tracing. Also, if and when someone does develop symptoms, clinicians are alerted early and can step up care right away.”

Today, Dr. Jacobs uses a “dashboard” that presents the current situation of dozens of COVID-19 patients to her in a way that allows her to monitor their progress. All the patients enrolled in the UT Health Home Monitoring program have their symptoms tracked day to day so Dr. Jacobs can see if they are doing better or worse over time. She filters patients who are at higher and lower risk, and she is using what she learns to develop algorithms that might help identify important turning points early, such as when patients need special attention or an urgent intervention.

“If anything good can be said to come of this coronavirus emergency,” she concludes, “it might be a lasting change in how medical professionals, and patients, use technology to interact. What we built with Sentinel, while specific to COVID-19 cases today, has major implications for all sorts of other conditions. From diabetes monitoring to COPD (cardio-pulmonary disease) and post-surgery wound healing, by combining telehealth systems that allow patients to use a secure online connection to see their clinician, ask and answer questions, and benefit from having data collected through various devices between visits, remote connectivity could make certain medical activities less complicated and more convenient. It could connect patients to specialists who they otherwise would have to spend hours or days traveling to see. And it could help bring a patient’s real situation, based on information about all the things that happen in a person’s life between office visits, which, let’s face it, is the vast majority of all our lives, into focus for the clinicians responsible for their care.”

“This pandemic is a serious and frightening thing. And it is forcing us all to find new ways to work. Technology-enabled remote monitoring and telehealth online visits are two ways to connect patients and clinicians. We are almost certainly going to continue using these kinds of systems after this crisis is past, which, in terms of service, convenience, and care continuity, will actually be a positive outcome of an otherwise very difficult event,” says Dr. Jacobs.

For more information about telehealth appointments at UT Health Austin, please visit our telehealth information page here. UT Health Austin Home Health Monitoring services are offered to patients diagnosed with COVID-19 and to their personal contacts for public health purposes.