Home monitoring of coronavirus disease 2019 patients in different phases of disease

Abstract

Purpose of review: Various home monitoring programs have emerged through the COVID-19 pandemic in different phases of COVID-19 disease.

Recent findings: The prehospital monitoring of COVID-19-positive patients detects early deterioration. Hospital care at home provides early discharge with oxygen to empty hospital beds for other patients. Home monitoring during recovery can be used for rehabilitation and detection of potential relapses. General goals of home monitoring in COVID-19 are early detection of deterioration and prompt escalation of care such as emergency department presentation, medical advice, medication prescription and mental support. Due to the innovations of vaccination and treatment changes, such as dexamethasone and tocilizumab, the challenge for the healthcare system has shifted from large numbers of admitted COVID-19 patients to lower numbers of admitted patients with specific risk profiles (such as immunocompromised). This also changes the field of home monitoring in COVID-19. Efficacy and cost-effectiveness of home monitoring interventions depend on the costs of the intervention (use of devices, apps and medical staff) and the proposed patient group (depending on risk factors and disease severity).

Summary: Patient satisfaction of COVID-19 home monitoring programs was mostly high. Home monitoring programs for COVID-19 should be ready to be re-escalated in case of a new global pandemic.

Box 1

no caption available

FIGURE 1

COVID-19 home monitoring in different phases of the disease. Individual COVID-19 disease severity determines the type of home monitoring. In the prehospital phase, meaning no previous admission except for an emergency department presentation, symptoms are mild to moderate, and patients are monitored for observation of deterioration. This possibly reduces observational admissions. Early discharge of improving COVID-19 patients with oxygen and medication including dexamethasone and antibiotics potentially shortens admission duration. Discharge of recovering patients without oxygen support with home monitoring gives patients support and detects early deterioration. ED, emergency department.

FIGURE 2

Schematic simplified overview of COVID-19 treatment and home monitoring systems over time. COVID-19 disease changed over time because of development of vaccines and medication (dates are according to European Medicines Agency or United States Food and Drug Administration authorization). Home monitoring developed over time as well. During the first wave monitoring of prehospital patients started, meaning no previous admission except for an emergency department presentation. From the second wave, early discharge of patients with hospital care at home (oxygen and medication) and monitoring recovery without in-hospital treatment started. In the future, monitoring systems should focus on risk groups. They should be ready for new (viral) pandemics and integrate with home monitoring for other diseases. IL, interleukin.