03-03-2021 | | By Liam Critchey
The COVID-19 pandemic has caused challenges around the world, but it has presented some opportunities as well. While many of us are likely to be fed up with lockdowns and restricted contact, the nature of the pandemic has meant that remote technologies have really come to the fore over the last 12 months.
Many people know about the rise of Zoom and other remote communication software and the emergence of online learning, but some medical areas have also seen many growth. These are telemedicine areas—i.e., remote medical monitoring, testing, and data transfer methods—and they have been implemented more than ever due to the highly contagious nature of the SARS-CoV-2 coronavirus (and the different variants) and the need for people to keep their distance from each other.
Telemedicine has been used in some forms over the years (the most basic being doctor’s telephone calls). There has been a rise in telemedicine approaches in the last year during the pandemic, and it’s thought that some of these approaches may stay in a post-pandemic world. Here, we look at a few ways how and why telemedicine has emerged during the pandemic.
First off, diagnostics. Diagnostic platforms have been one of the most important medical interventions during the pandemic. It has helped distinguish who has the virus and who needs to isolate themselves from others. The gold standard for a long period has been to use reverse transcriptase-polymerase chain reaction (RT-PCR) tests, however, this is quite slow. One way to distinguish who needs the test (and not overload the system) has been through pre-screening approaches (online or over the phone) to ensure that you are displaying the correct symptoms to warrant a test. While this is basic, it has helped to determine who needs a test without needing to see someone in person, and a lot more telemedicine options are emerging to complement the fundamental tests.
Since the RT-PCR tests, there have been several other, quicker tests that rely on telemedicine (even at a basic level). One of these has been the lateral flow test, which has been rolled out (at least in the UK) in many areas and offers a quick test with minimal interaction. While you do need to receive a test from someone, you can scan the QR code on the sheet from your phone and fill in details (you can get someone to fill in the details also), grab your test and then the results will be texted to your phone (SMS) around 30 minutes to 2 hours later. Without the large-scale telemedicine and data transfer infrastructure in place, this wouldn’t be possible, and we wouldn’t have rapid result testing in place.
There are also point of care diagnostic platforms being developed with nanomaterials that can detect the SARS-CoV-2 strain with a high degree of sensitivity and wirelessly send the results to an app on a phone or to a central data system. Another approach that has been proffered is the is a ‘COVID breath test’ where an array of nanosensors detect the coronavirus in a person’s breath and machine learning algorithms help to analyse the data to ensure that its accurate before sending the results.
Both approaches have been touted as options for home testing and remote health monitoring (using an app) instead of the swabs that you can receive at home—but even these tests are done without human interaction and rely on passing the results over remotely. So, even at this basic level you can see how telemedicine approaches have become fundamentally integrated with coronavirus testing.
Additionally, various general diagnostic platforms are emerging all the time, but not all will see real-world use. These include a range of microfluidic and biosensor platforms that have been designed to detect the protein spikes of the coronavirus (most using graphene) but not many are in commercial circulation, and there are others that provide a visual representation (colorimetric/fluorometric readout). Again, the trials using these types of diagnostic platforms send the data results to a centra data analysis and monitoring platform and alerts the person who took the test remotely about the result.
Regardless of the specific testing mechanism, the remote and digital nature of modern-day society means that this data can be taken and uploaded to central health monitoring systems, which can be used to track the spread of the virus and provide contact tracing among different populations (and hopefully, offer a way to track the symptoms of patients in all environments in the future).
One of the biggest telemedicine approaches throughout the pandemic has been test and trace systems (All countries have their own localised name for their specific system). These systems have been in place worldwide, and it allows anyone who comes into contact with someone who has tested positive to isolate themselves. This is where the central telemedicine system becomes important as it allows the testing data to be attributed to the person (and their phone). This allows the positive people to be tracked to let other people know if they have come into close contact with them. Still, it also helps to plan how the coronavirus could spread by tracking the hardest variable of them all to predict—human movement.
This data has allowed scientists (and algorithms) to extrapolate data from various factors to predict how the virus will spread and pick out any potential hotspot areas. It has also been an excellent preventative measure for ensuring that people who have potentially been exposed to the virus do not unintentionally pass it onto many others. In short, telemedicine in this regard has not only helped to track and predict the spread of the virus, but it has also helped to isolate it (if the person is willing to isolate—which is the hardest part of remote monitoring to control). Naturally, this has worked better in some areas of the world than others. There are many factors to consider, from the personal response of people who are meant to undergo isolation to the population density of a country, among many other factors, but the overall effect has been positive.
But health monitoring goes beyond this, and solutions are being developed to monitor the patients once they are ill. While there are plenty of equipment solutions for monitoring patients when they are in hospital, there is currently a drive to develop platforms that can help monitor patients who are isolating at home with the coronavirus.
This is inherently trickier, but some researchers are proffering solutions. Once again, advanced materials, and nanomaterials are offering a lot to sensing and monitoring platforms (due to the high sensitivity afforded by these types of materials) and this kind of potential is why the likes of the Advanced Material Future Preparedness Taskforce (AMPT) has been set up during the coronavirus pandemic.
Some of the proffered ideas include wearable sensors that can measure body temperature (as a fever is a common symptom) and other physiological biomarkers, to devices that can measure the respiration rate (and in turn oxygen concentration) of a person. The latter of these has been achieved using sensors mounted on people’s fingers and smartphones being used to detect oxygen levels, and some solutions have used respiratory sensors within specialist masks. So, there’s a lot of advanced sensing and monitoring solutions being proffered that could be used for remote monitoring of patients in their homes, but whether they can be rolled out an a large-scale (at least during the rest of this pandemic) remains to be seen and is probably be a challenge that will be present for a while—but the fundamental innovation is already in place.
Despite the pandemic's challenges, it has allowed everyone to do things remotely a lot more easily. From a telemedicine perspective, this ranges from very simple phone screening and results via SMS that don’t require interaction, to large scale test and trace systems and even vital sign monitoring of patients who are ill in their homes.
The emergence of more efficient data analysis and remote monitoring methods over the years has meant that more results are being processed, analysed and distributed remotely. This has been vital throughout the pandemic. This remote monitoring and testing trend could likely continue in some areas of medicine beyond the pandemic—as it saves time of doctor-patient interactions in situations where it may not be the most necessary to take up the doctor’s already-constrained time and allows more remote areas to access results much more easily.