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Frontline heroes: The digital battle against Covid-19

18 Sep 2021

With the scourge of the fourth wave of Covid-19 in Sri Lanka, a dire need was felt to effectively manage Covid-positive patients while responding to the healthcare needs of the general public. The healthcare system was at a tipping point; with increasing numbers of oxygen-dependent patients and rapidly decreasing hospital beds, there was an urgent need to bring all Covid-19-related services under one platform. To overcome the impending calamity, a mitigation strategy was formulated at an emergency meeting that was convened with various stakeholders. Subsequently, a national circular was issued to bring about an Integrated Helpline Information System. As a response to this national need, the Sri Lanka Medical Association (SLMA), the Ministry of Health, Suwa Seriya, and Mobitel joined hands with several telecommunications and mobile service providers to initiate a National Call Centre to help alleviate the crisis. We spoke to Prof. Indika Karunathilake, Prof. Manuj C. Weerasinghe, Prof. Athula Sumathipala, and Dr. Sajith Edirisinghe of SLMA, who are spearheading this historical digital triage system. The combined impact of the tireless efforts of frontline health professionals, the islandwide vaccination programme, movement restrictions, and the integrated helpline information system has reduced the burden on the critical healthcare services, thus facilitating better care for those who are critically ill. The Integrated Helpline Information System The Integrated Helpline Information System is an SMS gateway that was established by the Information and Communication Technology Agency (ICTA), in collaboration with the National Operation Centre for Prevention of Covid-19 Outbreak (NOCPCO), the Ministry of Health, the Telecommunications Regulatory Commission of Sri Lanka (TRCSL), and other prominent telecommunication service providers to merge the existing helplines and to bring all the information to a single platform, thus enabling optimal dissemination of information to the relevant parties for fast action. Some of its main aims were to establish a virtual triaging of health conditions for the evacuation of those who need urgent hospitalisation and to enable home management of patients by recording the patient’s condition and providing timely advice. [caption id="attachment_161945" align="aligncenter" width="559"] How the Helpline Information System works[/caption]   Providing care for those who are critically ill This system works on a triage basis. Where a healthcare provider or even the general public can send an SMS to 1904, indicating which category the patient is in by simply indicating the capital letter next to the severity: A – Covid-19 patients with breathing difficulty B – Covid-19 patients with symptoms C – Covid-19 patients with no symptoms The information thus captured will be directed to a medical team stationed at the operations room of the NOCPCO, where the patient will be evaluated over the phone to see if there’s a  necessity for urgent evacuation of said patient to a hospital. The details of those who need urgent medical care will be notified to the Suwa Seriya ambulance system, with a bed allocation from the focal point of the Ministry of Health for urgent evacuation. A dedicated information system is developed for this purpose. Currently, there is a team of doctors and pre-interns working in the NOCPCO operations room to handle patient calls, and a group of medical students supporting them. This portal ensures that those who require hospitalisation are given priority, and if they are asymptomatic or mildly symptomatic, they will be given necessary advice and asked to quarantine at home. In addition, the Western, North-Eastern (Northern and Eastern), and Southern Provincial Health Departments are directly linked to the system. They are provided with the list of patients in quarantine at home, with their details to follow up through a separate caller facility. Finally, patients who can be treated at home are named under a separate list, after which the NOCPCO forwards the list to the office of the Deputy Director General of Health (Medical Services) on a daily basis, in order to be incorporated into the 1390 home-base system. Therefore, the 1390 home-base care system benefits from the information provided by the 1904 SMS system to have a rapid notification of patients remaining at home with Covid-19. This initiative is a true success story of a digital triage system and, as evident, has minimised the burden on the healthcare system. Graph 1 is clear evidence that the situation is getting under control in the Western Province. It is based on an analysis done on 1,904 data segments from 5,000 households. “The rapid spread of infection within the Western Province households is gradually extinguishing. We can gain full control within the next three weeks with a concerted effort,” Prof. Karunathilake stated. Graph 1: Map of Sri Lanka depicting call density Prof. Karunathilake explained how this system has successfully responded to over 45,000 calls from households and helped close to 200,000 individuals, with over 900 ambulance evacuations and a minimum of 500 critically ill patients’ lives saved since its inception in mid-August. The cumulative efforts of those who worked together to establish this setup have now brought some relief to the hospital system. The tireless efforts of medical students, doctors, and specialists, including international experts and alumni of the medical faculties who came together, made an immense contribution. Responding to the need of pulse oximeters, many donations were made to the SLMA, which were successfully distributed to families that were in need. We also spoke to senior paediatrician Dr. Kalyani Guruge, along with several specialists who have been working with the Doc Call 247 service daily since the beginning of this service to gauge their experience. “During almost 50 years of being a doctor, 75% of this period spent as a paediatrician, I have experienced many natural as well as man-led disasters and been involved in crisis management. My contribution was always a paediatrician looking after affected kids. When Prof. Indika Karunathilake sought help from me in getting Doc Call 247 service into full gear, I never imagined what I was walking into by committing myself to listen to telephone calls and offer advice. Whether the caller is from Anuradhapura, Mulkirigala, Norochcholai, or Dambana, the calls were about adults with Covid-related problems reaching out to the most available helpline: SLMA or Doc Call 247. “A typical call could be described as a cascade of almost incoherent words, settling down halfway to clear questions while allaying their anxiety, and ending with showering blessings on the Doc Call 247 WhatsApp group. Although this helpline was initiated to mainly help patients in home isolation, we have moved into what I would call Doc Call 247 – beyond borders. The best example is the lottery seller who thought 247 is a number to call to vent her anger when the lockdown was extended. She was offered temporary assistance to tide over the difficult times with the help of Sarvodaya, and that went well beyond the original scope of the helpline. I believe Doc call 247 holds a special place, maybe among the first services in the world providing multidisciplinary care to citizens affected by Covid. I am proud to be a member of this endeavour,” stated Dr. Guruge. “Doc Call 247 has evolved in Sri Lanka to help the people desperate in a raging pandemic with escalating new cases and increasing daily death toll. It coincided with the Government’s decision to manage patients at their homes without sending them to hospitals or intermediate care centres as numbers were overwhelming. Initially, we were getting calls from families where several members had tested positive. “The best feature of this service is that experts from every field were there to help the volunteers. The callers were directed to specialists without delay. MOHs (medical officers of health) and PHIs (public health inspectors) were overwhelmed with the increasing numbers and as the weeks passed by, the goal of 24/7 services evolved into reducing numbers to hospitals, picking up red flags in patients who were not safe to be managed at home, and preventing deaths occurring in homes or before they reach hospitals. One of the great assets of this system is it’s linked to the Suwa Seriya system. It was so simple that all that was needed was to send the callers’ telephone numbers via a simple SMS and Suwa Seriya will take the patients to the hospitals wherever in the country they are from,” a senior physician commented. The dedication of the medical students and junior doctors is also especially commendable. They have been working diligently around the clock since the inception of this service, answering a flood of calls from needy and anxious patients, saving lives by guiding them to urgent care, and attending to a myriad of conditions. The majority of the patients who have used the system have mentioned that it was very informative and they were highly satisfied with the service. Hence, it’s correct to say that thousands of families have benefited and hundreds of lives have been saved as a result of this magnanimous feat. A student volunteer mentioned that they are empowered by the impact and the benefit the service has provided to both the public and to them personally. They look forward to this endeavour and the magnitude of the impact it has had can’t be described in words. He recalls that on the first day only two students were there, and since then many have volunteered to cover 16-hour shifts while continuing their academic activities. They felt it was a great learning opportunity and they thanked Prof. Weerasinghe and Prof. Karunathilake personally. He also said that this shows us that if as a profession we can come together at a time of national need, we can overcome any obstacles and move forward to serve our nation. [caption id="attachment_161948" align="aligncenter" width="550"] A few minutes to midnight. Young doctors and medical students responding to the queries of patients and helping them[/caption] Graph 2: Call statistics from the Helpline Information System (24 hours response rate of 247 Patient Helpline)  

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