A Telemedicine Approach to Covid-19: History
Please note this is an old version of this entry, which may differ significantly from the current revision.
Subjects: Pathology | Immunology

 COVID-19 is an RNA virus that has caused a pandemic leading to death and disability on a global scale. The virus gains entry into the cell using host protein angiotensin-converting enzyme-2 (ACE-2) receptor. The viral envelope fuses with the cell membrane through the endosomal pathway, allowing the viral particle to enter the host cell, where it can release its RNA and replicate. After an initial asymptomatic period, common presenting signs and symptoms of COVID-19 infection are non-specific and may include those of a common cold or influenza such as fever, dry cough, myalgia, headache and fatigue. Sore throat and nasal congestion may also be noted. Gastrointestinal and other symptoms may occur and loss of sense of taste and smell is a frequent early symptom that may distinguish COVID-19 from other respiratory infections. The virus is highly contagious and there is no cure. In order to avoid transmission, social distancing, mask wearing and reduced person-to-person interaction are key.  Definitive diagnosis is based on reverse-transcription PCR of nasopharyngeal and oropharyngeal swab samples. The clinical spectrum of the disease ranges from mild to moderate or severe. In order to minimize spread of COVID-19 to both patients and healthcare workers, virtual evaluation of suspected cases is being widely implemented and has necessitated an adjustment to the new medium by all participants. The use of virtual technology for real-time telemedicine assessment for COVID-19 provisional diagnosis and categorization of severity allows patients to receive an appropriate level of care without endangering others. We created a protocol for implementing a remote visit using a computer or mobile device. This enables patient assessement without direct contact to determine the need to visit a healthcare facility or alternatively, to be managed at home. If stable, the patient can isolate and be monitored so that should their condition worsen, they can be directed to in-person care at a hospital. Patients who develop severe COVID-19 may not note dyspnea and other signs of rapid deterioration until about 5-8 days after symptom onset.  



  • Covid-19
  • diagnosis
  • cytokine
  • telemedicine
  • physical examination

​  ​​​​​​​​COVID-19 has spread rapidly across the globe, causing significant loss-of-life. Outcomes vary widely from asymptomatic, to flu-like symptoms, to pneumonia and respiratory failure. Coagulopathy is now recognized as a marker of disease severity in patients with COVID-19. It is imperative that we understand why infections in certain individuals are so much more severe than in others. The most common complication that develops in COVID-19 is bilateral pneumonia.There is an urgent need to distinguish those patients who will have a mild disease course from those who are at-risk for respiratory failure and pulmonary intravascular coagulopathy and to reduce morbidity and mortality due to this virus. ​COVID-19 primarily infects respiratory epithelial cells and, through interaction with the extracellular domain of the angiotensin converting enzyme 2 (ACE2) receptor, airway epithelium is a key site for viral entry. Spread is person-to-person through droplets of saliva or nasal discharge during coughing, speaking or sneezing. It may also be acquired by contact with contaminated environmental surfaces. In order to avoid unnecessary exposure and potential transmission of COVID-19 in healthcare facilities and physician offices, telehealth has taken on an increasingly important role.

Table 1. COVID-19 Symptoms: initially may present like a common cold or flu​ ​

  • May have mild symptoms for about one week, then worsen rapidly
  • Fatigue
  • Dry cough
  • Fever
  • Sore throat
  • Runny nose
  • Muscle pain
  • Loss of appetite
  • Diarrhea
  • Nausea
  • ​Sudden loss of smell and/or taste**
    • ** Highly suspicious of COVID-19




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