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Scientific Article

The Pandemic and Health Care: Special Focus on Telehealth

Alexandre Kim Sangalan Sasaoka

The Pandemic

Coronaviruses are a major family of pathogens that affect humans and animals. At the end of 2019, a new coronavirus was identified as the cause of a series of cases of pneumonia in Wuhan, a city located in the Chinese province of Hubei. It spread quickly, resulting in an epidemic throughout the whole of China followed by an increase in cases in other countries all around the world. In February 2020, the World Health Organization named the disease “COVID-19”, which means “coronavirus disease 2019”.1
In January 2020, the World Health Organization declared the outbreak of COVID-19 a public health emergency and that the main ways to contain the spread of the disease were social (i.e. physical) distancing, hand hygiene and respiratory isolation, whereby people should remain at home as much as possible.2
Data regarding the real impacts of the pandemic on people’s health are still incomplete but preliminary information is available from various medical centers which shows a drop in the treatment of patients with chronic diseases.3,4
Many hospitals have canceled or postponed surgical and other procedures, including chemotherapy and radiotherapy. There continues to be a lot of concern regarding healthy patients and those with curable types of cancer requiring early diagnosis and treatment who are afraid of exposure to the virus and believe that the risk of contracting COVID-19 outweighs the benefits of any early cancer diagnosis and treatment.5
 All of these changes have resulted in a huge shift in the way that a population group which requires frequent care is monitored, as interrupting the prenatal monitoring of pregnant women is not an option.

The Pandemic and Pregnancies

Similarly, at the height of the pandemic, many couples decided to temporarily sideline the idea of becoming parents by postponing their attempts to conceive. There are no data showing the number of pregnancies that failed to materialize in 2020, but the drop in the number of women becoming pregnant at the start of 2021 was striking.6
That period of 2020 was characterized by learning and the development of expertise and technology for health care, including the monitoring of pregnant patients and those trying to conceive. Online health care, which is both swift and practical, was aligned with secure platforms for carrying out scheduled examinations, preventing large numbers of people from coming into close contact. In particular, there was a marked increase in demand for the types of platforms and technologies used by doctors in their clinics.
However, in many cases, there is still no technology sufficiently capable of replacing face-to-face appointments and physical examinations by an obstetrician, for example an assessment of vaginal discharge or a physical vaginal examination. As a result, telehealth is seen as a supplementary tool to in-person medical practices as it cannot yet replace face-to-face consultations, but is widely used for more straightforward queries or for providing guidance on how to use certain medication or interpret lab results. This prevents patients from having to leave their homes and go to doctors’ offices and reduces the risk of them contracting COVID-19.
Low-risk pregnant women are a prime example of a group of patients that can benefit from telehealth. This is due to the fact that low-risk pregnancy means any situation where the mother and baby do not present any type of disease. One such example has been seen in the United States, where 85% of pregnant women are considered low risk – the provision of health care via telehealth massively reduced the need for these patients to go to their doctor’s office, thus ensuring that these pregnant women could be cautious yet at the same time be well looked after.
Research conducted by the Mayo Clinic in the United States has shown that telehealth is a good option for low-risk pregnant women, on account of the effectiveness of self-monitoring, communication via online chats with healthcare providers, and a forum moderated by a nurse in which numerous pregnant women can talk to each other. The following benefits were clear to see:
  • Increased sense of control and safety
  • Low cost of health care provided
  • Increased access for severely ill patients
  • Improved patient satisfaction
  • Less time away from work
  • Partnership between support teams and pregnant women
Pregnant women in rural areas can be treated by healthcare professionals in other locations, providing a larger and wider support network and enabling access to specialists. This prevents these patients from having to travel and improves their quality of care.7,8

Statistical Data

Data show that 1 in every 10 pregnant patients stopped receiving face-to-face care in favor of being looked after remotely, whereby 87.5% of them opted to use the telephone in Australia.
The Australian Institute of Health and Welfare collated comparative data between 2019 and 2020 which showed that the number of face-to-face consultations fell by 136,000 which is an 8.3% drop. If we compare the second half of 2020 with the same period in 2019, the number of face-to-face consultations fell by 15%.9
The aim of the GLOW trial conducted in the United Kingdom, was to manage the weight gain of overweight or obese patients during pregnancy. Eligible pregnant patients had less weight gain and improved their lifestyle and their metabolic parameters compared to pregnant women who received face-to-face monitoring. Around 48% of the telehealth group, compared to 69% of the face-to-face group, experienced weight gain, however the trial was carried out using highly selected groups and so the findings might not be applicable to the wider population.10

Advantages and Disadvantages of Remote Health Care

During the first trimester of a pregnancy, weight gain and blood pressure must be monitored however this can be done by pregnant patients themselves and the data sent to their prenatal doctor, and there are already Internet-ready devices available that enable such assessments to be carried out. This is, of course, provided that there are no risk factors for the pregnant woman or the fetus.
One important aspect of face-to-face assessments primarily comes into play in the second trimester of a pregnancy when blood pressure, fetal growth and fetal heart rate need to be monitored particularly frequently.
Remote health care does have the downside that information provided by the patient’s body through body language and facial expressions cannot be read or assessed, and is therefore lost.
However, the advent of telehealth means that women living in rural areas can be treated by healthcare professionals based in other regions, thus providing them with access to specialists and a wider healthcare network, all without them having to travel long distances to visit major healthcare centers.11
There is no denying that face-to-face care is much more comprehensive than remote care but telehealth is a very convenient option for patients and can supplement face-to-face appointments and, in some cases, even replace them.12

Alexandre Kim Sangalan Sasaoka

Obstetrician/Gynecologist

Alexandre Kim Sangalan Sasaoka graduated in Medicine in 2007 from the Faculty of Medicine of the University of Santo Amaro in São Paulo, Brazil. He completed his three-year residency in Gynecology and Obstetrics at Santa Casa de São Paulo Hospital before going on to specialize in Fetal Medicine at the same institution. He improved his expertise in Fetal Surgery at the Children’s Hospital of Philadelphia in 2014 and currently works at his private clinic. He holds a master’s degree in Fetal Surgery in the field of Obstetrics at the Faculty of Medicine of the Federal University of São Paulo, and also provides public health care.

1World Health Organization. Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. http://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020 (Accessed on February 12, 2020).
2Honein MA, Christie A, Rose DA et al. Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020. MMWR Morb Mortal Wkly Rep. 2020;69(49):1860. Epub 2020 Dec 11.
3Yu J, Ouyang W, Chua MLK, Xie C. SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China. JAMA Oncol. 2020;6(7):1108.
4Lewis MA. Between Scylla and Charybdis - Oncologic Decision Making in the Time of Covid-19. N Engl J Med. 2020;382(24):2285. Epub 2020 Apr 7.
5Cannistra SA, Haffty BG, Ballman K. Challenges Faced by Medical Journals During the COVID-19 Pandemic. J Clin Oncol. 2020;38(19):2206. Epub 2020 Apr 8.
6ALVES, JED. Cai a natalidade e a fecundidade nos EUA depois da pandemia da covid-19, Ecodebate, 07/12/2020
7Marko, Kathryn I, et al. “Testing the Feasibility of Remote Patient Monitoring in Prenatal Care Using a Mobile App and Connected Devices: A Prospective Observational Trial.” JMIR Research Protocols, vol. 5, no. 4, 2016, doi:10.2196/resprot.6167.
8Mooij, Marnie J. Meylor De, et al. “OB Nest: Reimagining Low-Risk Prenatal Care.” Mayo Clinic Proceedings, vol. 93, no. 4, 2018, pp. 458–466., doi:10.1016/j.mayocp.2018.01.022.
9Liotta M. Pandemic Pregnancy Care: telehealth versus faco-to-face 2018 The Royal College of General Practioners, 2018
10Reynolds RM. Telehealth in pregnancy. Lancet Diabetes Endorcinol. 2020 Jun; 8(6):459-61.
11Reynolds RM. Telehealth in pregnancy. Lancet Diabetes Endorcinol. 2020 Jun; 8(6):459-61.
12Liotta M. Pandemic Pregnancy Care: telehealth versus faco-to-face 2018 The Royal College of General Practioners, 2018.