Telemedicine in home-based care for COVID-19 patients

The coronavirus pandemic is arguably the most serious global health crisis of the 21^st century. As of July 2022, more than 10.7 million people in Vietnam had been infected [1], with the recent fourth wave starting as the most disruptive yet. It developed in April 2021 and was marked by the emergence of the fast-spreading and highly contagious Delta variant. Across the country, Ho Chi Minh City swiftly became the epicenter of the COVID-19 pandemic, with medical institutions overloaded with infected cases and excess mortality seen in critically ill patients [2]. Seven months later, in November 2021, Omicron variant, which was less fatal and rendered the disease more manageable but highly contagious, took over [3]. Nevertheless, the pandemic remains a global health and economic crisis with long-term impacts on the community.

Telemedicine is the remote delivery of healthcare services via telecommunication platforms to serve patients and clients [4]. Its role during the pandemic has been manyfold, from triaging patients with severe illnesses who require early hospitalization to providing care for those with mild or asymptomatic COVID-19 which account for 80% of all cases and could be safely followed up at home [5, 6]. In this respect, it has been proven as an effective and satisfactory tool to prevent unnecessary hospital visits and the spread of the pandemic. This study was conducted to examine the utility and safety of telemedicine in caring for people with COVID-19 during both Delta and Omicron variants’ dominant periods.

Our study timeline spanned two phases of the COVID-19 pandemic that were characterized by the successive dominance of Delta and Omicron variants. During the first half, medical institutions in HCMC were severely overloaded with confirmed cases, especially critically ill patients. As a result, people with milder symptoms and at-risk populations (i.e., the elderly, people with underlying medical conditions) were much less likely to receive in-person care from healthcare professionals. In response to this situation, the Ministry of Vietnam encouraged the nationwide implementation of telemedicine, while HCMC's Department of Health promptly allowed for their use to provide remote care for people that could safely remain at home [9]. As a private medical facility, Jio Health was able to provide telemedicine service timely for the local community. In contrast, the second half of our study was characterized by the replacement of the less deadly Omicron variant. Nevertheless, people could still develop severe illness, require hospitalization and die from this variant, making home-based self-care without medical help highly unsafe and telemedicine a continuously necessary and attractive option.

Overall, we have demonstrated the safety of telemedicine implementation during both Delta- and Omicron-dominant phases of the pandemic among groups of patients with different demographic and clinical characteristics. The rates of hospital admission and death were low which were comparable to other studies [10, 11] (Table 4). Similar to previous reports, participants in the study were mostly younger adults, showing that this population could be more competent and willing to adapt to technology-based healthcare solutions [12]. Older adults, on the other hand, are also expected to benefit from telemedicine with adequate instruction or assistance from family members. Furthermore, most participants did not have any underlying medical conditions, a result also in line with past studies [13]. People during Delta dominance had a higher rate of comorbidities than those with Omicron dominance, which could be explained by a more popular appeal of telemedicine services among at-risk individuals. Interestingly, while Jio Health offices and clinics were located in HCMC, the service received appointment requests from people living in quite distant provinces, showing that the use of telemedicine surged considerably during Omicron dominant period. Even within HCMC, patients from the remote districts had the highest rates of using telemedicine service. Notably, there were strict policies about distancing within Vietnam and within cities like HCMC, especially in Delta dominant period. Our study, therefore, showed one of the advantages of telemedicine is being able to reach distant populations during a contagious pandemic.

The majority of participants in the study experienced mild symptoms. The presented clinical manifestations vary among patients infected with Delta and Omicron SARS-CoV-2 variants. Our study showed that COVID-19–highly specific symptoms such as loss of taste and smell were more frequently seen among people with Delta dominance, while those with Omicron dominance were likely to develop symptoms associated with upper respiratory tract infection. This is also consistent with previous findings from the UK and China which reported the prevalence of symptoms associated with an Omicron infection differs from those of Delta variant, apparently with less involvement of lower respiratory tract. This could be due to an adjustment in where the virus survives and multiplies from Delta to the newer Omicron variant [14, 15]. We also found that all hospital admissions in the study occurred during Delta-dominance period and people were sick for a significantly longer time, demonstrating the less severe profile of Omicron variant. This supports other findings from South Africa and South Korea, which showed milder severity and lower risk of hospitalization among people infected with Omicron than those infected with Delta [16‐18]. Our finding further suggests that COVID-19 might become endemic in the future and that telemedicine will continue to be an alternative way to deliver safe home-based healthcare for patients and prevent unnecessary hospital visits, as evidenced by a minimal rate of hospitalization (7%) in our study.

There are some limitations in our study. First, the identification of the variant results was not based on genomic sequencing, but on epidemiological findings which could not exclude the overlap between the two variants. Second, the retrospective study design restricted data assessment. Third, the exclusion of pregnant women and the low rate of elderly participants due to concurrent local guidelines for home-based care limited the performance of telemedicine [9]. Fourth, people living in rural areas with inadequate access to healthcare were underrepresented. Fifth, risk factors associated with hospitalizations were not examined.

Overall, our study demonstrated the role of telemedicine throughout the two phases of the COVID-19 pandemic, which were characterized by the deadly Delta variant causing severe disruption in the medical system, followed by the less lethal but highly transmissible Omicron variant. Telemedicine is a safe resource to care for COVID-19 patients at home.