Despite mass efforts of clinicians and other healthcare professionals in Massachusetts treating COVID-19 patients, the state now faces a potentially critical overwhelming of its hospital and ambulatory structure by sometime in April, according to healthcare leaders in the state.
Current and former healthcare executives penned a March 25 op-ed in the Boston Globe detailing the COVID-19 predicament, and why the state must rapidly use public and private assets to launch a comprehensive, tech-based program that can triage and safely support COVID-19 patients at home or in community-based venues.
The authors outlined three imperatives the program must address: support patients at home and in other venues mobilized by the state, provide some degree of respiratory and other essential medical support to individuals in case ventilators run out and reduce the burden placed on physicians, nurses and hospital staff.
To support patients in venues other than hospitals, the program should widely scale the state health department's mobile integrated health program. This would allow specially trained paramedics to use physician telemedicine consultations, a 24/7 nurse call center and remote laboratory and biometric monitoring to provide evaluations, testing and intervention for individuals with presumptive or confirmed cases of COVID-19.
The authors proposed repurposing ventilation devices used to treat sleep apnea and other conditions to support less ill individuals and free up intensive care unit beds. The use of telemedicine and remote monitoring of blood oxygen saturation using consumer devices will allow many patients to be safely monitored and care for in their homes.
"Many COVID-19 patients can be cared for safely in their homes. Many more could be managed with proper remote monitoring and reliable access to a telemedical care center," the authors wrote. "There is evidence that people with less severe respiratory symptoms may be treated safely with noninvasive ventilators, which are commonly available."
By implementing the first two imperatives, the third goal of reducing clinicians' burdens will be achieved, "even if only marginally," the authors concluded.
The authors of the op-ed are Robert Master, MD, former president and CEO of Commonwealth Care Alliance; Gary Gottlieb, MD, former CEO of Partners HealthCare System; David Margulies, MD, cofounder and director of Q-State Biosciences; Chris Kryder, MD, a primary care physician and commissioner of Massachusetts Health Policy Commission; John Loughnane, MD, former CMO of Commonwealth Care Alliance; and David Martin, MD, vice chair of innovative care solutions at Brigham and Women's Hospital.