SARS-COVID2 (COVID-19) has undoubtedly demonstrated its potential to infect virtually everyone in the human population, but encouraging data from Wuhan, Italy, Spain and New York indicate that only about 5% of the population are susceptible to severe infection requiring admission to intensive care units (ICU) and/or causing death. This vulnerable population has since been identified by pre-existing medical conditions and/or age. While 5% may initially seem like an insignificant number to many, in a South African population of 57.5 million, it represents potentially 2.9 million people.This represents a significant number of people most likely to require ICU admission and potential deaths, in a low to middle income country (LMIC) whose health system is already overburdened by HIV/AIDS.
Of all fatal cases experienced in New York state, two-thirds were in patients over 70 years of age; and about 90 percent of all fatal cases had an underlying illness. Of 6,570 confirmed COVID-19 deaths fully investigated for underlying conditions to date, 6,520, or 99.2 percent, had an underlying illness. Individuals with no underlying chronic condition were shown to have a small chance of dying, regardless of age.
One of the well documented risks for contracting COVID-19 is linked to exposure to crowded public places such as religious events, health care facilities and public transport.
While national lockdown and social distancing strategies may be appropriate and effective preventative mechanisms for the general population, current scientific evidence points to an even greater need to consider strict targeted measures aimed at protecting those that are vulnerable and at risk of suffering adverse health outcomes if infected.
This calls for limiting the exposure of at risk and vulnerable individuals from frequent contact with health care facilities and use of public transport, supported by targeted preemptive regular pre-screening of family members living with people at risk. The aim is to institute pro-active isolation and quarantine of suspected contacts that are most likely to infect the vulnerable.
It is possible to achieve protection of at risk individuals by leveraging the exponential power of ICT to bring community health workers (CHW) into mainstream-clinical-work, providing them with smart phone enabled with digital health solutions that are endowed with augmented artificial medical knowledge systems, clinical decision support tools and automated patient scheduling capability. Current mHealth platforms are capable of delivering such machine driven, automated chronic disease management solutions designed for remote patient monitoring and peer to peer consultations that allow for real-time sharing of patient clinical information between CHW, nurses and doctors.
A South African project addressing this problem employs this methodology by enrolling at risk and vulnerable individuals to a home-based, active chronic disease management program that links patients to care from the household, the individual, community health care centers and to a group of doctors located at a centralized remotely located “SARS-COV2 war-room” that offers real-time clinical advice and continuum of care for patients who are enrolled in the program.
The role of CHW is to optimize care for diabetics, hypertensives and COPD patients by ensuring that each individual is as hemodynamically and clinically stable as possible during the COVID-19 pandemic. CHW are provided with e-bikes that increase their mobility and reach. They deliver chronic medicine door to door, and conduct on-site blood pressure measurements and blood glucose testing using Bluetooth enabled digital medical devices
They also use an interactive digital COVID-19 pre-screening tool to identify possible COVID-19 household members living with at risk individuals, recommend COVID-19 testing for people who are found to be illegible, and offer supervised quarantine or isolation of individuals who meet the criteria for COVID-19.