Covid patients not eligible for home recovery can now do so with 'virtual wards'

Some hospitals here have been setting up Covid-19 "virtual wards" so that those whose conditions are stable, but are ineligible for the home recovery programme, will also be allowed to recover from the comfort of their homes.

These patients include those who are unvaccinated, those on immunosuppressive medication, and patients with chronic medical conditions.

The National University Health System’s (NUHS) virtual ward has helped more than 500 Covid-19 patients so far, saving 3,500 bed days since September last year, said Dr Stephanie Ko, a consultant at the Division of Advanced Internal Medicine, at the National University Hospital’s Department of Medicine.

The ward has also enrolled several Omicron cases, and it is prepared to help with bed capacity if the Covid-19 surge hits, she told The Straits times on Tuesday (Jan 4).

The treatment in the virtual ward is similar to that in a Covid-19 treatment facility or hospital - with doctors and nurses doing “ward rounds” daily or every other day through teleconsultation, and to ensure that the patients measure their vital signs routinely, said Dr Ko. 

The care team can also visit patients’ homes if required - such as to administer drip-based medication to help high-risk Covid-19 patients reduce their risk of developing severe pneumonia, or to do blood tests. 

“In the Covid-19 virtual ward, our nurses teach patients how to monitor their own temperature, oxygen levels and blood pressure. Patients with smartphones are enrolled into our vital signs chatbot, which reminds them to take these readings and submit them via an online form up to three times daily,” she added.

For patients without smartphones, they are loaned a tablet with Bluetooth-connected measurement devices, so that they can take their readings, which the virtual ward care team is able to view through a dashboard.

“Around half of our patients were referred from one of our cluster’s three hospitals - National University Hospital, Alexandra Hospital or Ng Teng Fong General Hospital - after a period of hospital stay.

“The other half were referred to us directly from community providers such as National University Polyclinics or the Case Management Task Group at the Ministry of Health (MOH), for patients who were at home and wished to continue recovery at home rather than go to a facility,” said Dr Ko.

Such patients are either elderly - 80 years old and above - and fully vaccinated, or more than 50 years old and not fully vaccinated, have chronic medical conditions or weakened immune systems, such as patients who are on chemotherapy or have had organ transplants.

Some patients dying from Covid-19, but wished to do so at home, have also been supported through the programme, she noted.

Similarly, the Singapore General Hospital (SGH), which set up its Covid-19 virtual ward on Oct 8, has enrolled 120 patients so far, said Dr Michelle Tan, the consultant-in-charge of the ward, and the head and consultant at the hospital’s Department of Family Medicine and Continuing Care.

Patients under this programme are monitored remotely with the help of a messaging bot known as Doctor Covid, where they are required to report their vital signs such as oxygen saturation levels, pulse rate and temperature three times a day, said Dr Tan in a media interview on Tuesday (Jan 4).

Some patients may be required to take their blood pressure as well, and the necessary equipment can be loaned to those who need them, she added.

Those who are not tech-savvy will have nurses call them regularly to check on their vital signs and to ensure that they are doing well at home, Dr Tan said.

The bot, co-developed by SGH, SingHealth and the Agency for Science, Technology and Research, had initially been used in migrant worker dormitories during the peak of the outbreak there in April 2020, and has been repurposed for the virtual ward, she noted.

Currently, two groups of patients qualify for the virtual ward - those who have more complex medical conditions and are transferred from the hospital's Covid-19 isolation ward, and those who qualify for recovery at community treatment facilities but prefer to recover from home.

All patients must be at least 18 years old, and can either be vaccinated or unvaccinated, though those who are unvaccinated "by choice" will have to foot their own medical bills, said Dr Tan.

One patient who has gone through the Covid-19 virtual ward programme is caregiver Kelly Chavel, who is on lifelong immunosuppressive medication after having received a heart transplant five years ago.

Ms Chavel, 49, who is partially vaccinated, said she tested positive for Covid-19 on Dec 5, and experienced mild symptoms throughout - including sore throat, running nose and cough.

"After spending nine days in SGH's isolation ward, I was discharged to isolate at home for another 11 days, where I had to take my vital signs thrice daily. The nurses would call regularly to check on me. I felt very assured to have the medical team supporting me," she added.

Dr Tan said patients who wish to recover from home instead of from a community treatment facility can do so under the programme after being assessed for their suitability.

Since rolling out the virtual ward, more than 800 bed days in the isolation ward have been saved, freeing up capacity for more patients, she added.

Noting that Singapore is bracing itself for a possible Omicron wave in February or March, Dr Tan felt that the virtual ward would play a "very relevant role" in such a scenario.

Currently, it has the capacity for 100 patients at a time, though it has a surge capacity for up to 200 patients when needed, she added.

"Through our experience of running the Covid-19 virtual ward for the last few months, I think we will definitely be able to expand our capacity to better support the situation and offset the patient load in hospitals."