A systematic review and meta-analysis, which included eight (8) studies of lab-confirmed COVID-19 infections and a total of 46248 infected patients from hospitals in China, has found that underlying disease, including hypertension, respiratory system disease and cardiovascular disease, may be risk factors for severe COVID-19 infection (1).
It is crucial that those with chronic illnesses and underlying diseases are prevented from being infected by the COVID-19 virus and at the same time, maintain optimal control as far as their disease condition is concerned. However, it must be stressed that in the effort to achieve optimal control of their chronic illnesses, the healthcare system and its processes must not put these patients at risk for being infected with COVID-19.
The reality is, patients with chronic illnesses and underlying diseases are still turning up to outpatient clinics for their follow-ups, where the probability of coming into close contact with someone who is infected with COVID-19 is higher. And then, there are those who completely defaulted their outpatient clinic appointments for fear of being infected with COVID-19, whose chronic conditions are now not being monitored at all.
Healthcare leaders need to immediately find and implement a solution that balances between mitigation of COVID-19 infection risk and effective monitoring of disease condition among chronic illness patients, especially given the fact that the pandemic is going to last for many months. Postponement of outpatient appointments or provision of online outpatient booking system is not sufficient or effective over the long haul.
Enter telemedicine. Telemedicine, which refers to the practice of medicine using audio, visual and data communications (2), is governed by the Telemedicine Act 1997. According to the act, a fully registered medical practitioner holding a valid practising certificate may practise telemedicine. It also states that the medical practitioner must obtain written consent from the patients prior to providing telemedicine services.
Telemedicine which enables patients with chronic illness avert outpatient clinics would reduce the patients’ chances of encountering someone with COVID-19 infection thereby reducing their risk of infection substantially. At the same time, doctors would be able to monitor patients’ chronic illness conditions and continue to provide adequate care while patients are safe within the confines of their own homes.
Telemedicine is not completely foreign to the general public. It has been implemented during this pandemic in the provision of medical advice for those with symptoms of COVID-19 infection through the National Crisis Preparedness and Response Centre (CPRC) hotline and Virtual Health Advisory. However, its outpatient clinic version (telemedicine clinic), which allow clinical consultations to chronically ill patients are yet to be available.
So, what’s stopping telemedicine clinics from being rolled out nationally? Firstly, it may be difficult to obtain written consent from patients without unnecessarily exposing them to risk of COVID-19 infection (by asking them to present themselves to the clinics just to give written consent), although some may argue that there are legal ways around it that may overcome this challenge without contravening the Telemedicine Act.
Also, resources required to practise telemedicine as it should be, are deemed insufficient. Healthcare managers need to think creatively and not compare our capability with those in highly developed countries. We may not be able to provide our doctors with laptops connected to the Hospital Information System, but we could allow voice- or video-calls from doctors in clinics to patients at home, as long as confidentiality is maintained.
And then there is the issue of medical indemnity which at this point in time do not cover the practice of telemedicine (3). But, this issue should be amendable with enough support from the Ministry of Health. Formal decision and announcement from leaders in the Ministry of Health with regards to the permissibility of telemedicine practice given the current crisis will enable supportive elements such as medical indemnity to be worked out.
We need to recognise that there is a significant and urgent need to protect those at high risk of COVID-19 infection from being infected while caring for their underlying chronic illnesses during this pandemic. All our current solutions are only addressing one or the other. Telemedicine clinic, which addresses both, is sufficient as a beneficial long-term solution and must be supported by leaders from all levels within the healthcare system.
Telemedicine clinics are going to change the way we practise medicine and alter patients’ expectations of the healthcare delivery system. Adoption of telemedicine apps in Germany, UK, Norway and Sweden have soared over the last couple of weeks amidst infection concerns surrounding the provision of care of chronically ill patients (4). It is time that chronic illness patients in Malaysia are also provided with such services.
- Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis
- Telemedicine Act 1997
- Allow Telemedicine, Malaysia Urged, After Study Finds Higher Covid-19 Risk For Cancer Patients
- Covid-19: Quarantined doctors turn to video chats so they can see patients