Telehealth Covid-19 Diagnostic Prognosis

Yahweh van Ram, Sri 

Singapore University of Social Sciences, Maximum Wellness Centre

Protocol (Covid-19 Research)

Yahweh van Ram, Sri

Telehealth has become critical during the pandemic because of the asymptomatic spread of the coronavirus leading to Covid-19. Shallow breathing or abnormal shallowness of the respirations is one of the symptoms of Covid-19. Oxford University has demonstrated that smartphone technologies are questionable to be used for measuring blood oxygen saturation abbreviated SpO2 (Tarassenko, 2020). The health and medical community, in view of Covid-19 pandemic, must find comparative and reliable resources to inform their practice that prevents the onset of an overdemand in health and medical resources. The elderly population is deemed to be a target population prone to infections and diseases (Nazario, 2020). As an alternative, the use of a standard pulse oximeter on the patient’s finger is a standard practice to measure hypoxia that is a serious warning sign for Pneumonia (Greenhalgh, 2020). According to Gossman (2019), “The mechanism of hypoxia is the process whereby oxygen carried by hemoglobin, direct interaction between red blood cells in pulmonary capillaries and the air in the alveoli is needed”. Hypoxia differs from hypoxemia; this can result from inadequate oxygen delivery to the tissues either due to low blood supply or low oxygen content in blood (hypoxemia) and when oxygen delivery is severely compromised, organ function will start to deteriorate, this occurs with the hypoxia condition (Gossman, 2019). Severe cases of covid-19 develop to Pneumonia and critical infections may be treated with ventilators to support breathing, currently a wide mortality range, from 22% to 62% in the early Hubei Province (Murthy, 2020). This research will investigate the relevance of Telehealth communication platforms as a tool for data collection and impact of mask-wearing and its effects in a high-risk group, the elderly population. The focus of the study is to 1) implement the low-cost mode of testing  2) possible opportunity to purchase devices and/or mass manufacture this solution for ready-mass distribution 3) To increase public confidence to continue working and socialising as the virus continues to remain in society.

Keywords:  SpO2, Pulse Oximeter, Covid-19, Hypoxia, Mask-wearing

Telehealth Covid-19 Diagnostic Prognosis

Oxygen saturation is the fraction of oxygenated haemoglobin relative to the total haemoglobin (oxygenated + deoxygenated) in the blood. SpO2 = [HbO2] / ([Hb] + [HbO2]) Where HbO2 is oxygenated haemoglobin and Hb is deoxygenated haemoglobin (Tarassenko, 2020). According to Murthy (2020), people who get Pneumonia may also have a condition called Acute Respiratory Distress Syndrome (ARDS) is a severe condition that prevents the lungs from functioning by fluid built up. Preventive measures from governments and their health organisations’ recommends COVID-19 Pneumonia Prevention, Advisories to preventing the onset of Covid-19 includes the following points; 1) Wash your hands often using soap and water for at least 20 seconds. An alternative to hand wash being hand sanitizer gel at least 60% alcohol 2)  Not to touch your face, mouth, or eyes until you’ve washed your hands 3) Stay at home notices and avoid public gatherings 4)  Regularly clean and disinfect surfaces (Nazario, 2020).

 Etiology

The etiology of Pneumonia is disease attributed to lung inflammation and Community-acquired pneumonia can be caused by an extensive list of agents that include bacteria, viruses, fungi, and parasites for COVID-19 pneumonia (Nazario, 2020). Progressive Hypoxia relates to the onset of pneumonia and is it imperative to consider morbidities of patients referencing the model disease diagnosis and prognosis, how diseases progress highlights the importance of diagnostic prognosis that will be addressed in this research from the use of the device and telehealth technologies.

Objective

The elderly population is deemed to be a target population prone to infections and diseases (Nazario, 2020). As an alternative, the use of a standard pulse oximeter on the patient’s finger is a standard practice to measure hypoxia that is a serious warning sign for Pneumonia (Greenhalgh, 2020). According to Gossman (2019), “The mechanism of hypoxia is the process whereby oxygen carried by hemoglobin, direct interaction between red blood cells in pulmonary capillaries and the air in the alveoli is needed”. Hypoxia differs from hypoxemia; this can result from inadequate oxygen delivery to the tissues either due to low blood supply or low oxygen content in blood (hypoxemia) and when oxygen delivery is severely compromised, organ function will start to deteriorate, this occurs with the hypoxia condition (Gossman, 2019). Severe cases of covid-19 develop to Pneumonia and critical infections may be treated with ventilators to support breathing, currently a wide mortality range, from 22% to 62% in the early Hubei Province (Murthy, 2020). A solution to the Problem This research will investigate the relevance of Telehealth communication platforms as a tool for data collection and impact of mask-wearing and its effects in a high-risk group, the elderly population. 

The aim of this report is to describe the process and outcomes of the following points seen below using IBM statistics tool SPSS T-Test Analysis and Qualitative Analysis for the Mixed methods approach: 

• The Accuracy of the SpO2 against Perceived Rate of Exertion, based on Resting Heart Rate
• Mask-Wearing in Relation to SpO2 and Perceived Rate of Exertion, based on Resting Heart Rate
• Common Comorbidity in Relation to Elderly Covid-19 subjects
• Usefulness of Telehealth as a virtual method of engagement with Elderly Covid-19 subjects Activities and Patient and stakeholder engagement plan 

The use of the Pulse Oximeter and Usefulness of Telehealth as a virtual method of engagement with Elderly Covid-19 subjects will provide valuable insights reduce the risk of infections by means of spreading community awareness about covid19 and its effects on the elderly population. The Oximeter is to measure heart rate and peripheral capillary oxygen saturation (SpO2) this may indicate the oxidative stress levels because using an Oximeter to measure percentage of oxygenated haemoglobin and heart rate index via the fingertip has benefits that include the non-invasive method, the cost to acquire the device is relatively low and affordable, may inform health and medical practitioners on telehealth strategies to reduce the risk of infections and flatten the statistical covid-19 curve. 

Methods

The population sample will be a subset of the covid-19 infected countries. The multicultural city of Singapore will be the focal point of the study, having the opportunity to investigate different ethnic groups is instrumental to the success of the research. To address the vulnerable population (N=120) will be the elderly population and 50% of the sample are subjects diagnosed with covid-19. To uphold the integrity of the research, the ethics code and laws of the country on personal data protection will be abide to with informed consent. There will be incentives for willing participants to disclose their diagnosed covid-19 condition and their health history as data to inform the study. All personal identities will be kept in confidence as the study will include telehealth tools to mediate communication and reports for 8 months of engagement. Unique capabilities will include 1) The storage, testing, transport and delivery of the Pulse Oximeter Device.  2) Technologies for Telehealth communication tools.

The research grant will provide the Principal investigator funding towards salary, research assistants, devices such as pulse oximeter, tokens voucher to participants, access to journal databases, fieldwork, and workshops.

References

 Gossman, W. (2019, July 11). Anoxia (Hypoxic Hypoxia). Retrieved May 06, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK482316/

Greenhalgh, T., Koh, G., & Car, J. (2020, March 25). Covid-19: A remote assessment in primary care. Retrieved May 06, 2020, from https://www.bmj.com/content/368/bmj.m1182?sort_by=field_highwire_a_epubdate_value

Jörg, H. (2010, November 19). Cerebrum Illuminans: Mass Spectrometric Analysis of Protein and Peptide Dynamics in Neurological Diseases. Retrieved May 06, 2020, from http://uu.diva-portal.org/smash/record.jsf?pid=diva2%3A359600

Nazario, B. (2020, April 07). Pneumonia and Coronavirus: Does Everyone With COVID-19 Get Pneumonia? Retrieved May 06, 2020, from https://www.webmd.com/lung/covid-and-pneumonia

Murthy, S. (2020, April 21). Care for Critically Ill Patients With COVID-19. Retrieved May 06, 2020, from https://jamanetwork.com/journals/jama/fullarticle/2762996

Tarassenko, L., & Greenhalgh, T. (2020, May 05). Can we use smartphones to measure oxygen saturation? Retrieved May 06, 2020, from https://www.cebm.net/covid-19/question-should-smartphone-apps-be-used-as-oximeters-answer-no/

Article in Consultation 

Peng, Z. Y. (2020, February 11). Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View. Retrieved May 18, 2020, from https://clinicaltrials.gov/ct2/show/NCT04264533