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1. Safe Discharge Home With Telemedicine of Patients Requiring Nasal Oxygen Therapy After COVID-19

Author

Aurélien Dinh, Jean-Christophe Mercier, Luc Jaulmes, Jean-Yves Artigou, Yves Juillière, Youri Yordanov, Patrick Jourdain, The AP-HP/Universities/INSERM COVID-19 Research Collaboration, Dinh Aurélien, Mercier Jean-Christophe, Artigou Jean-Yves, Juillière Yves, Jaulmes Luc, Yordanov Youri, Jourdain Patrick, Apra Caroline, Mensch Arthur, Aime-Eusebi Amélie, Bleibtreu Alexandre, Debuc Erwan, Dechartres Agnes, Deconinck Laurene, Dinh Aurelien, Katlama Christine, Lebel Josselin, Lescure François-Xavier, Artigou Yves, Banzet Amelie, Boucheron Elodie, Boudier Christiane, Buzenac Edouard, Chapron Marie-Claire, Chekaoui Dalhia, De Bastard Laurent, Grenier Alexandre, Haas Pierre-Etienne, Hody Julien, Jarraya Michele, Lacaille Louis, Le Guern Aurelie, Leclert Jeremy, Male Fanny, Marchand-Arvier Jerome, Martin-Blondet Emmanuel, Nassour Apolinne, Ourahou Oussama, Penn Thomas, Ribardiere Ambre, Robin Nicolas, Rouge Camille, Schmidt Nicolas, and Villie Pascaline

Subjects
COVID-19, pneumonia, oxygen therapy, home monitoring, telesurveillance, Medicine (General), R5-920
Abstract

Introduction: The COVID-19 pandemic created challenges to healthcare systems worldwide. To allow overwhelmed hospitals to focus on the most fragile and severely ill patients, new types of management had to be set up. During the pandemic, patients with COVID-19 from greater Paris area were monitored at home using a web-based remote system called COVIDOM™, using self-administered questionnaires, which triggered alerts to a regional control center. To ease hospital discharge and to prevent hospital from being overwhelmed, patients still requiring low-flow oxygen therapy discharged home were also included in this telemedicine solution. We aim to evaluate the safety of this original management.Methods: We conducted a retrospective multicenter cohort of patients discharged home from hospital after COVID-19 and still requiring nasal oxygen therapy, who were monitored by questionnaire and trained physicians using COVIDOM. During late follow-up, the status of the patients using a Euro-Qol (EQ-5D-5L) questionnaire, and the Medical Research Council (MRC) Dyspnea scale was collected.Results: From March 21st to June 21st 2020, 73 COVID-19 patients still receiving nasal oxygen at hospital discharge were included. Median [Inter-Quartile Range (IQR)] age was 62.0 [52.5–69.0] years, 64.4% were male. Altogether, risk factors were observed in 49/73 (67%) patients, mainly hypertension (35.6%), diabetes mellitus (15.1%) and active neoplasia (11.0%). Among the cohort, 26% of patients were previously managed in ICU. Oxygen therapy was required for a median [IQR] of 20 [16–31] days. No death or urgent unplanned hospitalization were observed during the COVIDOM telemonitoring. During the late follow-up evaluation (6 months after inclusion), the mean EQ-5D-5L questionnaire score was 7.0 ± 1.6, and the mean MRC dyspnea scale was 0.8 ± 1.0, indicating absence of dyspnea. Five patients have died from non-COVID causes.Conclusions: In this preliminary study, early discharge home of patients with severe COVID-19 disease who still required low-oxygen therapy seems to be safe.

Published
2021
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2. Time to resolution of respiratory and systemic coronavirus disease 2019 symptoms in community setting

Author

Aurélien Dinh, Luc Jaulmes, Agnès Dechartres, Clara Duran, Hélène Mascitti, Xavier Lescure, Youri Yordanov, Patrick Jourdain, Apra Caroline (AC), Jaulmes Luc (JL), Mensch Arthur (MA), Aime-Eusebi Amélie, Apra Caroline, Bleibtreu Alexandre, Debuc Erwan, Dechartres Agnes, Deconinck Laurène, Dinh Aurélien, Jourdain Patrick, Katlama Christine, Lebel Josselin, Lescure François-Xavier, Yordanov Youri, Artigou Yves, Banzet Amélie, Boucheron Elodie, Boudier Christiane, Buzenac Edouard, Chapron Marie-Claire, Chekaoui Dalhia, null De Bastard Laurent, Grenier Alexandre, Haas Pierre-Etienne, Hody Julien, Jarraya Michèle, Lacaille Louis, Le Guern Aurélie, Leclert Jeremy, Male Fanny, Marchand-Arvier Jerôme, Martin-Blondet Emmanuel, Nassour Apolinne, Ourahou Oussama, Thomas Penn, Ribardiere Ambre, Robin Nicolas, Rouge Camille, Nicolas Schmidt, and Villie Pascaline

Subjects
Adult, Male, Microbiology (medical), medicine.medical_specialty, Symptom duration, Comorbidity, Coronary Artery Disease, Body Mass Index, Cohort Studies, Coronary artery disease, Sequelae, Pulmonary Disease, Chronic Obstructive, Risk Factors, Interquartile range, Internal medicine, Diabetes mellitus, Dyspnoea, Outpatients, medicine, Humans, Respiratory system, Asthma, Coronavirus disease 2019, business.industry, Age Factors, COVID-19, General Medicine, Middle Aged, medicine.disease, Telemedicine, Research Note, Infectious Diseases, Heart failure, Community setting, Female, Median body, business, Cohort study
Abstract

Objectives To assess the time to resolution of respiratory and systemic symptoms and their associated factors in outpatients during the coronavirus disease 2019 (COVID-19) pandemic. Methods Cohort study including adult outpatients, managed with Covidom, a telesurveillance solution, with RT-PCR-confirmed diagnosis, from 9 March 2020 until 23 February 2021. Follow up was 30 days after symptom onset. Results Among the 9667 patients included, mean age was 43.2 ± 14.0 years, and 67.5% were female (n = 6522). Median body mass index (BMI) was 25.0 kg/m2 (interquartile range 22.1–28.8 kg/m2). Main co-morbidities were: hypertension (12.9%; n = 1247), asthma (11.0%; n = 1063) and diabetes mellitus (5.5%; n = 527). The most frequent symptom during follow up was dyspnoea (65.1%; n = 6296), followed by tachypnoea (49.9%; n = 4821), shivers (45.6%; n = 4410) and fever (36.7%; n = 3550). Median times to resolution of systemic and respiratory symptoms were 3 days (95% CI 2−4 days) and 7 days (95% CI 6−8 days), respectively. Ultimately, 17.2% (95% CI 15.7%−18.8%) still presented respiratory symptoms at day 30. Longer time to respiratory symptom resolution was associated with older age, increased BMI, chronic obstructive pulmonary disease, coronary artery disease, asthma and heart failure. Regarding systemic symptoms, coronary artery disease, asthma, age above 40 years and elevated BMI were associated with longer time to resolution. Conclusions Time to symptom resolution among outpatients with COVID-19 seemed shorter for systemic than respiratory symptoms. Prolonged respiratory symptoms were common at day 30. Risk factors associated with later resolution included age, and cardiovascular and pulmonary diseases.

Published
2021
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