• Because of the coronavirus pandemic, it is safer for medical practitioners to consult their patients remotely

• Great strides have been made in the efficiency and effectiveness of ‘telemedicine’

• A remote doctor provides you with a diagnosis and sends any prescriptions to the pharmacy of your choice

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When I was a young doctor a few decades ago, my fellow medical practitioners and I debated on how a novel technology known as “telemedicine” could be used to deliver healthcare from a distance to rural populations. 

At the time many of us smirked. We pondered who would willingly give up a personal relationship online? How safe can or could this be? How could anyone believe that the “laying on of hands” could be replaced by a practitioner miles away through a cell or desk phone, laptop or IPAD or just a desktop computer?

For years, I maintained some measure of scepticism. Despite advancements in technology, I did not believe that we could feel the same connection, the same understanding, with our primary care patients through a remote encounter.

Best time to learn new things

And then bang, the novel coronavirus (Covid-19) engulfed the world and I was forced to cancel local and international face-to-face meetings in favour of virtual ones and realised this is the best time to learn new things, which included embracing telemedicine and/or virtual consultations.

During the debate with my fellow medical practitioners at the time, we discovered that telemedicine or telehealth was first introduced during the mid-1900s to 1980s. It was used by astronauts and the navy. 

Telehealth or telemedicine was designed to offer medical help to people even though they were far from the hospital. However, due to various limitations and restrictions, telemedicine is often the last resort of hospitals.

One of the critical things we needed to grasp during the debate was the idea of changing – changing systems, changing ideas, changing protocols.

Now in a crisis like this, a clear context of what to do to cope with change has become valuable. This is quite challenging as we have never dealt with something like this before. Covid-19 is a change that shook the whole world and forced us to adjust to the “new normal”.

As a former practising doctor who has now taken the leap to telemedicine, I can attest to how simple and efficient telemedicine truly is. 

With telemedicine, you meet the doctor over the phone or video chat instead of in an in-person consultation. 

You discuss your symptoms and medical history with the doctor, who provides you with a diagnosis and sends any prescriptions to the pharmacy of your choice.

New era of healthcare

Indeed, the coronavirus, which has forced us to embrace physical distancing in the absence of a vaccine, has accelerated this new era of healthcare. Over the past four months, we have moved from almost 100% in-person visits to the majority of our care delivered virtually.

Amid the pandemic, telehealth companies are connecting patients to vital healthcare services through videoconferencing, remote monitoring, electronic consultations, and wireless communications. 

Indeed, because of Covid-19, numbers of virtual doctor visits have surged. Healthcare providers are trying to contain the spread of the virus by giving medical advice to patients remotely. Only the most serious cases receive treatment in person. 

This is also valuable for patients who need routine care for other medical conditions and for medical professionals who must continue to help the sick. Healthcare workers at hospitals, for example, are using iPads to communicate with patients in isolation. Virtual health service is being complemented by the “pick-up and drive-thru” services which were rolled out even before the advent of Covid-19 and “pharmacy on wheels”.

Hospitals and doctor’s rooms have become an important focus point during lockdowns, and demand for medical services continues to grow exponentially as the pandemic spreads.

Besides Covid-19, the demand for treatment for medical conditions – like diabetes, heart disease, organ transplant, asthma and advanced age – continues unabated.

Capability, creativity and resilience 

The coronavirus has brought to the fore everyone’s capability, creativity, and resilience. We never knew how capable we were of embracing technologies like telemedicine until we were forced to do so. 

Videoconferencing apps are making it easier not only for employees to work remotely to reduce the risk of spreading the coronavirus, but also for the sick to consult a medical practitioner.

It is amazing how, for people isolated by the coronavirus epidemic and others who don’t just want to take any risks, the tech sector has become a new best friend with an array of lifestyle solutions making “physical distancing” easier.

Telemedicine is making gains. Indeed, the technology used in telemedicine or telehealth is helping to reduce the risk and cost of infection to patients and medical staff alike, and has become a wonderful tool during the time of Covid-19.

Examples 

The medical services offered are similar to being at a clinic, hospital or doctor’s rooms, except that the consultation is done virtually. Photos or any other requests to the doctors must be sent online. This supplements other kinds of digital health that have been around for decades. 

Albert Luthuli Hospital, regarded as one of the most successful public-private partnership in healthcare in South Africa, has been running its radiology department digitally with all X-rays, magnetic resonance imaging scans and CT (computed tomography) scans sent digitally between providers and patients. 

We need to do all we can to facilitate the digital healthcare delivery that the recent pandemic requires. 

Adopting a universal standard for telehealth 

Recently I watched one of my associates, a radiologist, analysing the data of a distantly located patient, which made me increasingly convinced that modern technology can help us render quality healthcare even in the most rural of areas. Each and every patient should now be able to enjoy the same level of treatment regardless of their location.

Even as we embrace technology during these unprecedented times, we should not forget how the Covid-19 pandemic has amplified the importance of effective public service. The dedicated health workers who are often unappreciated and targeted by a frustrated public, are redefining the “front lines” and what it means to serve the public good. Their warm smiles, healing touch and careful observance of vital diagnostic signs and other clues, can never be replaced by any technology.

After Covid-19, I believe virtual consultations will become even more widely used, especially by patients with mobility problems. We need to adopt a universal standard for telehealth, which will require transparency and consensus-based practices to better guide developers, providers, and patients.

Covid-19 has demonstrated the vital importance of ongoing and robust investment in technology and the development of digital health. 

*Dr Anna Mokgokong is chairperson of the Afrocentric Group, South Africa’s largest health administration and medical risk management solutions provider, which owns health companies such as Medscheme

^{Image credit: Getty Images, additional photo supplied}

Dr Anna Mokgokong

• Loss of smell and taste continue to surface as clue to Covid-19
• New study offers some ideas as to how this may happen
• Not all Covid-19 patients present with loss of smell and taste

Lost sense of smell (anosmia) and diminished sense of taste (dysgeusia) have surfaced in recent weeks as peculiar symptoms of Covid-19 (the diseases caused by SARS-CoV-2) infection. And a recent case report of a 25-year-old radiographer who underwent magnetic resonance imaging (MRI) illustrates how this may happen.

MRI offers insight

The report, published in the journal JAMA Neurology, explains that the female patient had no significant medical history, and that she had initially presented with a mild dry cough that lasted for a day. This was then followed by persistent severe anosmia. However, the patient did not have a fever.

The patient then had a brain MRI performed three days later. The authors looked at 3D and 2D fluid-attenuated inversion recovery images, which showed that a cortical hyperintensity was evident in the right gyrus rectus – a portion of the brain, usually vulnerable to traumatic injury, that is located at the very middle of the frontal lobe of the brain. They also found the presence of a subtle hyperintensity in the olfactory bulbs – an essential structure in the olfactory system which is devoted to the sense of smell.

The patient also underwent a swab test, and reverse transcription-polymerase chain reaction analysis indicated positive results for SARS-CoV-2.

The three authors of the report wrote that, based on the patient’s MRI findings, it can be speculated that the virus may invade the brain through the olfactory pathway and cause an olfactory dysfunction of sensorineural (linked to the sensory nerves) origin. However, they mention that further studies are required to confirm this hypothesis:

“Ours and others’ observations of normal brain imaging in other patients with Covid-19–associated olfactory dysfunctions and the disappearance of the cortical MRI abnormalities in the follow-up study of this patient suggest that imaging changes are not always present in Covid-19, or might be limited to the very early phase of the infection.

“Further, anosmia can be the predominant Covid-19 manifestation, and this should be considered for the identification and isolation of patients with infection to avoid disease spread.”

A follow-up MRI was done 28 days later, and, according to the report, results revealed that the patient had recovered from anosmia. The authors further wrote that in two other Covid-19 patients who had also presented with anosmia and underwent brain MRIs, no brain abnormalities were noted.

Other studies reporting on loss of smell

Health24 reported on another study published in April this year that indicated loss of smell to be more likely to occur in patients with mild to moderate Covid-19 than in those with more severe illness. The researchers explained that this information could be helpful to healthcare providers as it could indicate early on which patients may require hospitalisation.

Another study, also reported on by Health24, involved positive Covid-19 patients who reported significant loss of smell and taste, but added that the rate of recovery of smell and taste was high, and generally occurred within two to four weeks of infection.

Due to these numerous reported cases, the US Centers for Diseases and Control (CDC) updated their set of guidelines of Covid-19 symptoms last month to include six new ones, among them, loss of taste or smell.

Compiled by Zakiyah Ebrahim

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All hugs are not created equal – and babies as young as four months are proof.

Heart rates in infants less than a year old slowed more during a hug than a hold. And the hug had a greater effect when it came from Mom or Dad rather than from a stranger, according to a study published in April in the journal iScience.

The findings offer some of the first proof that hugs help parents and infants bond, the researchers said.

“Like most parents, we love to hug our children,” said first author Sachine Yoshida of Toho University in Tokyo, Japan. “We also know that children love to be hugged by their parents. But what surprised us as scientists is how little we know about hugging.”

Benefits go both ways

For the study, her team assessed infants’ heart rates when they were hugged or held. And those aged four months to one year calmed more when they were hugged than when they were held.

The babies’ heart rates also slowed more when they were hugged by their parents compared with a hug from a stranger, the findings showed.

And the calming benefits go both ways: Parents’ heart rates also slowed when they hugged their infants.

“We found that both infants and parents come to relax by hugging,” Yoshida said in a journal news release.

While a parent’s hug didn’t have quite the same effect on younger infants, one trick did help them relax: Holding baby and using a hand to put pressure on his or her back.

This suggests that younger babies don’t make the same distinction as older ones between being held and being hugged, according to the researchers.

“Even though infants cannot speak, they recognise their parents through various parenting methods, including hugging, after four months old at latest,” Yoshida said. “We hope that knowing how your baby feels while being hugged helps ease the physical and psychological workload of taking care of infants too young to speak.”

^{Image credit: Unsplash}