Forum: Telemedicine can help prevent local outbreak

A photo illustration of telemedicine apps.
A photo illustration of telemedicine apps.PHOTO: ST FILE

I was president of the Singapore Medical Association 17 years ago during the severe acute respiratory syndrome (Sars) outbreak and have some suggestions on how to better deal with the Wuhan virus situation.

It is now clear that the Sars virus and the Wuhan virus develop in very different ways despite both being coronaviruses.

With Sars, almost every patient had a fever, and until that happened, he was not at risk of infecting others. With the Wuhan virus, however, it is highly likely that during the incubation period (of up to 14 days), some infected people will experience only mild symptoms, little different from a common cough and cold.

Worse, even when without symptoms, some may spread the virus to others around them. It seems that the only reliable early differentiator is the patient's travel history, or the fact of having been in contact with a person who has travelled to a high-risk region.

Such patients are then isolated, and subsequently confirmed as having the virus or discharged, based on the results of a blood test.

The current instruction to persons at risk is to head to their general practitioner (GP) clinic if they feel unwell. This is illogical. The GP has no exceptional means of distinguishing patients with the Wuhan virus from others with a common cough and cold.

All he can do is to ask for details of recent trips and about close contacts. No physical examination or blood test is available to help him reach a diagnosis.

Such questions about travel or contacts should not be kept to the GP visit. I suggest that the Ministry of Health urgently set up some telemedicine hotlines, manned by trained bilingual personnel.

All travellers arriving at Changi Airport can be instructed to call that number if they feel unwell.

The telemedicine hotline staff can ask the relevant questions, with the traveller in the relative safety of his hotel room.

Callers assessed as needing further evaluation can be told to wait for a dedicated ambulance to arrive. This way, the hour-long wait in a GP's clinic is eliminated, as well as the possible spreading of the virus to many others waiting together.

The current instruction to persons at risk is to head to their general practitioner (GP) clinic if they feel unwell. This is illogical. The GP has no exceptional means of distinguishing patients with the Wuhan virus from others with a common cough and cold.

Since the days of Sars, communications technology has developed tremendously. The initial screening of ill patients via telemedicine seems a perfect fit for new technology.

It may even reduce the risk of an outbreak, starting from a GP's clinic and proceeding to the community.

Lee Pheng Soon (Dr)

A version of this article appeared in the print edition of The Straits Times on January 29, 2020, with the headline 'Telemedicine can help prevent local outbreak'. Print Edition | Subscribe