Ambulatory monitoring of patients with COVID-19: initial experiences and next steps

© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Since cases were first described in December 2019, SARSCoV2 has posed a distinct challenge to healthcare delivery, and Ireland has been no exception. Hospital bed numbers per capita in Ireland are at 2.9 per 1000 inhabitants, bed occupancy is the highest in the European Union, care is predominantly delivered in 4 to 6bedded wards, and singleroom isolation facilities are in short supply, risking being overwhelmed by high caseloads. Droplet spread within environments increasingly appears to travel further than the initially predicted 2 m 3 and one Irish hospital has reported as many as 49% of their COVID19 cases occurring via nosocomial transmission, and higher (32%) mortality in this group. We therefore identified a need to manage patients safely at home to minimise spread to susceptible patients and staff. As SARSCoV2 infection’s natural history includes a rapid deterioration, characteristically in the second week of the illness in those who develop severe disease, 6 the challenge of safely caring for such patients in the community was raised. Given that COVID19 causes pneumonitis and impaired oxygenation, it is advised that patients with mildmoderate COVID19 are monitored for progression. Finger probe oxygen saturation (SpO 2 ) monitoring is therefore a feasible method of home monitoring. Within months of the pandemic being declared a number of centres internationally (including those within Australia, Canada, China, The Netherlands and the UK) began to implement COVID19 virtual monitoring programmes, taking a variety of forms, ranging from telephone support alone to remote assessments of patients’ symptoms in combination with collecting biometric data. Ireland’s national Health Service Executive (HSE) developed an early partnership with the digital health firm patientMpower in February 2020, with rollout of a new Summary box