The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence

Coronaviruses, a genus of the coronaviridae family, may cause illness in animals or humans [1, 2]. In humans, several coronaviruses are known to cause infections of respiratory ranging from the common cold to more serious diseases. The most recently discovered coronavirus causes coronavirus disease-19 (COVID-19) [1]. The disease originated in Wuhan, China and has kept spreading widely to other regions of the world [3]. Primitive symptoms of COVID-19 contain fever, dry cough, breathing difficulty, and boredom [4, 5]. Elderly people and those with underlying medical problems such as hypertension, heart problems, and diabetes are more susceptible to develop the disease in its form of most intensive [1]. This universal event has been announced a pandemic by the World Health Organization (WHO) [6]. A significant factor in slowing down the transmission of the virus is the “social gap” or social distancing that is made possible by the reduction of person-to-person contact [7, 8].

To reduce transmission, travel restrictions have been appointed and enforced around the world, and most cities have been quarantined [9]. However, people who are not infected with the COVID-19, especially those who are at greater risk of developing the disease (e.g. Elderly people and those with underlying diseases), should receive daily care without the risk of exposure to other patients in the hospital [7]. Moreover, under strict infection control, unnecessary personnel such as clinical psychiatrists strongly refuse to enter COVID-19 patient’s ward [10, 11]. Natural disasters and epidemics pose many challenges in providing health care [12]. As a result, unique and innovative solutions are needed to address both the critical needs of patients with COVID-19 and other people who need healthcare service. In this respect, technological advances provide new options [13]. Although the ultimate solution for COVID-19 will be multifaceted, it is one of the effective ways to use existing technologies to facilitate optimal service delivery while minimizing the hazard of direct person-to-person exposure [7, 14]. The use of telemedicine at the time of epidemic conditions (COVID-19 pandemic) has the potential to improve research of epidemiological, control of disease and management of clinical case [7, 14, 15].

The use of telehealth technology is a twenty-first century approach that is both patient-centered and protects patients, physicians, as well as others [16, 17]. Telehealth is the delivery of health care services by health care professionals, where distance is a critical factor, through using information and communication technologies (ICT) for the exchange of valid and correct information [18]. Telehealth services are renderdusing real-time or store-and-forward techniques [19]. With the rapid evolution and downsizing of portable electronics, most families have at least one device of digital, such as smartphones [20] and webcams that provide communication between patient and healthcare provider [21]. Video conferencing and similar television systems are also used to provide health care programs for people who are hospitalized or in quarantine to reduce the risk of exposure to others and employees [7]. Physicians who are in quarantine can employ these services to take care of their patients remotely [8, 22]. In addition, covering multiple sites with a tele-physician can address some of the challenges of the workforce [8, 23].

There are various benefits in using technology of telehealth, especially in non-emergency / routine care and in cases where services do not require direct patient-provider interaction, such as providing psychological services [24]. Remote care reduces the use of resources in health centers, improves access to care, while minimizing the risk of direct transmission of the infectious agent from person to person [25]. In addition to being beneficial in keeping people safe, including the general public, patients and health workers, another important advantage is providing widely access to care givers [12].. Therefore, this technology is an attractive, effectual and affordable option [14, 26, 27]. Patients are eager to use telehealth, but hindrances still exist [28, 29]. The barriers of implementing these programs also largely depend on accreditation, payments systems, and insurance [8]. Furthermore, some physicians are concerned about technical and clinical quality, safety, privacy, and accountability [23, 30].

Telehealth can become a basic need for the general population, health care providers, and patients with COVID-19, especially when people are in quarantine, enabling patients in real time through contact with health care provider for advice on their health problems. Thus, the aim of this review was to identify and systematically review the role of telehealth services in preventing, diagnosing, treating, and controlling diseases during COVID-19 outbreak.

The aim of this systematic review was to identify the role of telehealth services in preventing, diagnosing, treating, and controlling diseases during COVID-19 pandemic. In this review, we explained the benefits and implications of several tools of telehealth with the purpose of improving the management of COVID-19 infection. Nowadays, the best preventive strategy is to avoid being exposed to the coronavirus, because there is no vaccine to overcome COVID-19 in the all countries [41]. A series of strategies have been proposed for infection prevention and control (IPC) that may diminish the exposure risk, such as wearing of face masks in mass population, Covering mouth and nose with tissue when coughing and sneezing, continuous hand washing with soap and water or hand sanitizer containing at least 60% alcohol, avoidance of close contact with others and keeping true social distance, and refraining from touch of unwashed hands with eyes, nose, and mouth [42].

Meanwhile, to reduce the number of those who receive face-to-face services of health care, healthcare workers can contact with patients through telecommunication tools for triaging, assessing and caring for all patients [43]. Telehealth with use of live video conferencing or a simple mobile call allow health care professionals to ask special questions and collect required information, triage of patient and supply consultation, or if a person can continue to self-monitor symptoms at home while recovering. It can also be applied for regular check-ins such as respiratory, blood pressure and oxygen level rate needed in home [34].

During the COVID-19 outbreak in China, online mental health surveys with communication programs, such as Weibo, WeChat and TikTok have enabled mental health professionals and health authorities to render safety mental health services online during the COVID-19 pandemic [44]. Chinese government officials launched a remote consultation network that can be carried out internet or telephone consultations in a safe setting to ensure the continuous provision of mental health services and reduce the hazard of cross infections [45]. Also, the National Health Commission of China have published several online guideline and free electronic books about COVID-19 with the aim of helping the progress of Chinese people emergency interventions, safety, improving the quality and effectiveness of emergency interventions [10]. In addition, telehealth can provide mental online health services in the setting of patient isolation by reducing the mental health burden from COVID-19 and sharing information about symptoms of burnout, depression, and anxiety [14].

Greenhawt et al. suggested that telehealth has several benefits in providing allergy and immunology services such as limiting exposure of health professionals to potentially infected patients and access to the rapid evaluation for COVID-19 infection [38]. in addition to the conventional methods used in diagnosing COVID-19, the study identified a novel screening and triage strategy during deadly COVID-19 pandemic in Iran. Services for teleradiology and teleconsultation for triage of COVID-19 infection through a social media massager delivered by Iranian Society of Radiology (ISR) to response to the shortage of on-site thoracic radiologists during COVID-19 pandemic [33]. In addition to taking actions to protect the health and safety of patients, also staff should take mobile health technology to develop staffing plans and carry out billing for healthcare services [39].

Our results demonstrate that to manage COVID-19, there are many easy-to- set-up potentials in live video consulting. Live video conferencing can lead to the avoiding of direct physical contact, thereby diminishing the risk of exposure to respiratory secretions and preventing the potential transmission of infection to physicians and other healthcare providers [34]. Also, live video could be very useful for patients seeking consultation on covid-19, for people with heightened anxiety and instead of in-person visits in cases of chronic disease reviews (such as diabetes and cancer), some medication checks, and triage when telephone is insufficient [23]. In order to control the spread of the COVID-19 outbreak, video consultations and telephone follow-up is possible in multiple cancer settings including lung, endometrial, colorectal, and prostate [37].

Based on the study conducted in the USA, phone calls and electronic health records (EHR) can facilitates screening or treating a patient without the need for in-person visits and improve decision making process among healthcare team in an ambulatory and urgent care [35]. Generally, the impact of telehealth during the COVID-19 pandemic in preventing morbidity and avoiding of presence the public from high-risk areas such as hospital premises was significant. Also, the elderly people can access health services by using electronic devices [36]. These days, suitable adaptation of local systems with changes regarding to payment and coordination of services are major barriers for the large-scale use of telehealth to deal with COVID-19 infection [8]. Finally, we hope can make substantial progress in preventing and controlling COVID-19 pandemic through further training of health providers and patients on how to make the most of telehealth tools, revisiting traditional definitions of clinical practice and using closed online platforms.

This study provides a comprehensive systematic review solely exploring the potentials of telehealth during the COVID-19 pandemic. In response to WHO’s call for studies on the COVID-19 infection and presentation of the most recent evidence published in this early period of the outbreak for health care providers, this study was conducted to identify the role of telehealth during COVID-19 outbreak. As the COVID-19 epidemic scales exponentially across the worlds, calls for expended use of telehealth as innovative solutions, clearly highlight unmet needs in the world healthcare system. Telehealth has the potential to address many of the key challenges in providing health services during the outbreak of COVID-19. Also, telehealth can help us avoid direct physical contact and minimize the risk of COVID transmission and finally provide continuous care to the community. Based on the findings of this review study, clinicians and patients are strongly recommended to apply telehealth tools as an appropriate option to prevent and contain COVID-19 infection.