Coronavirus (COVID 19) – Treatment with telemedicine

Background of Coronavirus (COVID-19)

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Coronaviruses are zoonotic i.e. they are transmitted between animals and people. It has been reported that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans. Now there is an outbreak of respiratory disease caused by a novel (new) coronavirus that was first detected in China and which has now been detected in more than 100 locations internationally, including in the United States. This new strain of virus has been named “SARS-CoV-2” and the disease it causes has been named “Coronavirus Disease 2019” (abbreviated “COVID-19”). The coronavirus is named after the crown like spikes that protrudes from its surface resembling sun’s corona. This new strain of coronavirus has not been previously identified in humans. The SARS-CoV-2 virus is a beta coronavirus, like MERS-CoV and SARS-CoV.

The novel coronavirus detected in China is genetically closely related to the SARS-CoV-1 virus. SARS emerged at the end of 2002 in China, and it caused more than 8 000 cases in 33 countries over a period of eight months.  About 10% of the people who developed SARS died. The first case of novel coronavirus can be traced back to Wuhan in China’s Hubei Province, when a 55 year old person contracted the infection on November 17, 2019.  On 31 December 2019, a cluster of pneumonia cases of unknown aetiology was reported in Wuhan, Hubei Province, China. On 9 January 2020, China’s National Health Commission reported a novel coronavirus in the SARS-CoV phylogenetic clade as the causative agent of this outbreak. The disease is now referred to as novel coronavirus disease 2019 (COVID-19). Reports say that this initial outbreak in Wuhan had some link to a large seafood and live animal market, suggesting animal-to-person spread. Later, a growing number of patients reportedly did not have exposure to animal markets, indicating person-to-person spread. Person-to-person spread was subsequently reported outside Hubei and in countries outside China, including in the United States. It then became epicentre as it rapidly spread at home and abroad. Cases are now being detected across the globe.

Mode of transmission and Symptoms of COVID-19 infection

COVID-19 and seasonal influenza are transmitted from person-to-person and may cause similar symptoms but the two viruses are very different and do not behave in the same way. The mortality rate for COVID-19 is much higher than the seasonal influenza but significantly less than the 2003 SARS outbreak. Despite the relatively low mortality rate for seasonal influenza, many people die from the disease due to the large number of people who contract it each year. The concern about COVID-19 is that, unlike influenza, there is no vaccine and no specific treatment for the disease. As it is a new virus, nobody has prior immunity which in theory means that the entire human population is potentially susceptible to COVID-19 infection. However, everyone with flu symptoms doesn’t need to get tested for COVID-19.

While animals are the original source of the virus, it is now spreading from person to person (human-to-human transmission).  The virus seems to be transmitted mainly via respiratory droplets that people sneeze, cough, or exhale. The virus can also survive for several hours on surfaces such as tables and door handles. The incubation period for COVID-19 (i.e. the time between exposure to the virus and onset of symptoms) is currently estimated between 2- 14 days. At this stage, we know that the virus can be transmitted when people who are infected show flu-like symptoms. If it is mild then symptoms would be fever, cough, difficulty in breathing, muscle pain and tiredness. More serious cases develop severe pneumonia, acute respiratory distress syndrome, sepsis and septic shock that can lead to death. Older people and people of all ages with severe underlying health conditions — like heart disease, lung disease and diabetes, for example — seem to be at higher risk of developing serious COVID-19 illness. Healthcare workers caring for patients with COVID-19 are at elevated risk of exposure. Close contacts of persons with COVID-19 also are at elevated risk of exposure. Travelers returning from affected international locations where community spread is occurring also are at elevated risk of exposure.

COVID-19 Now a Pandemic

On January 30, 2020, the International Health Regulations Emergency Committee of the World Health Organization (WHO) declared the outbreak a “Public Health Emergency of International Concernexternal Icon” (PHEIC). On January 31, 2020, Health and Human Services Secretary Alex M. Azar II declared a public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to COVID-19. On March 11, the COVID-19 outbreak was characterized as a pandemic by the World Health Organization (WHO) external icon. Pandemics happen when a new virus emerges to infect people and there is little to no pre-existing immunity against the new virus, it spreads worldwide. This is the first pandemic known to be caused by the emergence of a new coronavirus. In the previous century, there have been four pandemics caused by the emergence of novel influenza viruses. As a result, most research and guidance around pandemics is specific to influenza, but the same premises can be applied to the current COVID-19 pandemic. Pandemics framework begins with an investigation phase, followed by recognition, initiation, and acceleration phases. The peak of illnesses occurs at the end of the acceleration phase, which is followed by a deceleration phase, during which there is a decrease in illnesses. Different countries can be in different phases of the pandemic at any point of time and different parts of the same country can also be in different phases of a pandemic.

USA has also declared the National emergency on March13, 2020.  The Centres for Disease Control & Prevention (CDC) is the leading National public health Institute under the US Department of Health & Human Services. In US different parts of the country are seeing different levels of COVID-19 activity. Overall it is currently in the initiation phases, but states where community spread is occurring are in the acceleration phase. The duration and severity of each phase can vary depending on the characteristics of the virus and the public health response. More and more states are reporting cases of COVID-19 to CDC. In the United States COVID-19 cases include: Imported cases in travellers, Cases among close contacts of a known case and Community-acquired cases where the infection source is not known.

Risk Assessment of COVID-19 (Coronavirus)

For a better understanding, a country can be in one of the following four stages of an epidemic.

Stage I      Early cases are primarily imported from affected countries.

Stage II     Local transmission begins from positive cases. Transmission is limited to people        who have come in direct contact with an infected individual with travel history. USA and India are currently in this stage.

Stage III   There is large-scale spread in community. Transmission is occurring in patients who have had no direct contact with COVID-19 patients with travel history. It is spreading in community and affecting larger clusters.

Stage IV   The disease takes shape of a nationwide epidemic with no clear endpoint. China and Italy, for example, are in this stage.

In the absence of vaccine or treatment medications, non-pharmaceutical interventions become the most important response strategy to try and delay the spread of the virus and reduce the impact of disease. The risk from COVID-19 to Americans can be broken down into risk of exposure versus risk of serious illness and death. The immediate risk of being exposed to this virus is still low for most Americans, but as the outbreak expands that risk will increase. More cases of COVID-19 are likely to be identified in the United States in the coming days, including more instances of community spread. CDC expects that widespread transmission of COVID-19 in the United States may occur. Cases of COVID-19 and instances of community spread are being reported in a growing number of states. Widespread transmission of COVID-19 could translate into large numbers of people needing medical care at the same time. Schools, childcare centres, and workplaces, may experience more absenteeism. Mass gatherings may be sparsely attended or postponed. Public health and healthcare systems may become overloaded. Other Healthcare providers and hospitals may be overwhelmed. At this time, there is no vaccine to protect against COVID-19 and no medications approved to treat it. Therefore, community interventions will be the most important response strategy.

Global efforts at this time are focused concurrently on lessening the spread and impact of this virus. The federal government is working closely with state, local, tribal, and territorial partners, as well as public health partners, to respond to this public health threat. Everyone can do their part to help in combating this emerging public health threat from getting and spreading respiratory illnesses like COVID-19.

Challenges prevalent in American Health System

While countries around the globe are struggling to deal with the coronavirus, people in the US must contend with a fragmented health system where just going to get tested can mean hundreds or thousands of dollars in medical bills — a risk those in other developed countries don’t face. There are three main problems that most Americans are facing.

(i) Lack of coverage and high costs

The US is the only developed nation without universal health care. About 10%, Americans were uninsured in 2018, according to the most recent Census Bureau data available. Before the Affordable Care Act was passed in 2010, 18% people were without insurance. The uninsured largely depend on a patchwork of community clinics and hospital emergency rooms for care. This means they often wait until their conditions become serious before seeking medical help — which could lead to their infecting many others during viral outbreaks like coronavirus. But even those who have insurance may not seek care that quickly, largely because they face hefty deductibles and out-of-pocket costs for doctor’s visits, emergency room trips and treatment.

(ii) Lack of paid sick leave

Another weak point in the nation’s fight against the coronavirus’ spread is the lack of national standards on paid sick leave. Among the lowest-paid employees, only half have access to sick leave. Most of the independent contractors don’t receive benefits such as sick leave. Another effect of the lack of paid sick leave is that many sick people will go to work causing the virus to spread more widely. Some workers such as finance or professional services can work from home but percentage of such people is very small. In leisure and hospitality less than 10% are able to work from home.

(iii) Lack of primary care doctors, ICU beds and respirators

The US has roughly 3 general or family practitioners per 10,000 people as compared to 7.5 in the United Kingdom, 9 in France and 13 in Canada. As a result many Americans don’t have a regular primary care doctor, and those that do could have trouble in reaching them after hours or on weekends. The fact is that the primary doctors are always in a better position to decide whether their patients have pre-existing conditions that would require more treatment.  Findings show that the vast majority of those diagnosed with Covid-19 will be able to recover at home, however the lack of availability of doctors is a great challenge. Only a few will need to be hospitalized, but  If their numbers rise sharply, hospitals may have trouble accommodating them, since most of the hospitals have a limited number of intensive care unit rooms and trained staff to handle the patients. Care at home not only minimizes the chances of spreading the coronavirus but also avoid overburdening hospitals and clinics. Having enough supplies, particularly N95 respirators, is also a concern. Healthcare staff uses the respirators if they suspect someone might have the illness. N95 respirators have been in short supply globally as countries treat their coronavirus patients.

How to avoid catching or spreading coronavirus

Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing. It is also recommended to stay 1 metre or more away from people infected with COVID-19 who are showing symptoms, to reduce the risk of infection through respiratory droplets. Some of the precautions that can be taken are:


  • wash your hands with soap and water often – do this for at least 20 seconds
  • always wash your hands when you get home or into work
  • use hand sanitiser gel if soap and water are not available
  • cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • put used tissues in the bin immediately and wash your hands afterwards
  • try to avoid close contact with people who are unwell


  • Do not touch your eyes, nose or mouth if your hands are not clean.
  • Travel advice – There are some countries and areas where there’s a higher chance of coming into contact with someone with coronavirus. So check it before planning to travel abroad.

Treatment for coronavirus

If you are a close contact of someone with COVID-19  or a resident in a community where there is ongoing spread of COVID-19 and  feeling ill with COVID-19 symptoms (such as fever, cough, difficulty breathing, muscle pain or tiredness), it is recommended that you contact healthcare services by telephone or online. If your healthcare provider believes there is a need for a laboratory test for the virus that causes COVID-19, he/she will inform you of the procedure to follow and advise where and how the test can be performed. There is no specific treatment for this disease, so healthcare providers treat the clinical symptoms (e.g. fever, difficulty breathing) of patients. People who are mildly ill are able to isolate at home there is no need for hospitalization. Supportive care (e.g. fluid management, oxygen therapy etc.) can be highly effective for patients with symptoms.

If you are infected, the use of surgical face masks may reduce the risk of you infecting other people, but there is no evidence that face masks will effectively prevent you from being infected with the virus. In fact, it is possible that the use of face masks may even increase the risk of infection due to a false sense of security and increased contact between hands, mouth and eyes.

There are currently no vaccines against human coronaviruses, including the virus that causes COVID-19. This is why it is very important to prevent infection and to contain further spread of the virus. The development of vaccines takes time. Several pharmaceutical companies are working on vaccine development. It may however, take months or years before any vaccine can be widely used, as it needs to undergo extensive testing to determine its safety and efficacy.

How can telemedicine help?

The clinical presentation of COVID-19 ranges from asymptomatic to severe pneumonia with acute respiratory distress syndrome, septic shock and multi-organ failure, which may result in death. Analyses of cases suggest that COVID-19 infection causes mild disease (i.e. non-pneumonia or mild pneumonia) in about 80% of cases. Most cases recover, 14 % have more severe disease, and 6% experience critical illness requiring specialist medical care, including mechanical ventilation . The majority of the most severe illnesses and deaths have occurred among the elderly and those with other chronic underlying conditions. As COVID-19 is caused by a newly identified virus, there is no therapeutics or vaccines available. The highest risk of healthcare-associated transmission occurs in the absence of standard precautions, when basic infection prevention and control measures for respiratory infections are not in place, and when handling patients whose COVID-19 infection is yet to be confirmed. A sizable number of populations are clueless about the disease and traumatized. They need not only the pharmaceutical treatment but also need some counselling by the Psychiatrists.

PS3G Inc. has developed and launched a health-technology platform – DocVilla. DocVilla is a HIPAA compliant, secured platform to connect the patients and the doctors through telemedicine and in-person consults. Patients can select the state licensed doctor, schedule an appointment for video or in-person consults and select the pharmacy where the prescription needs to be delivered. The patient is charged only when the doctor completes the consult. DocVilla has a registered trademark and a pending patent. DocVilla was initially launched as a telemedicine platform but has since evolved into a full-fledged EMR. DocVilla has also got a significant traction from hospital systems, urgent care facilities and medical practices Some of the important features of DocVilla are patient portal, video and in-person appointment scheduling, electronic notifications, pharmacy selection for receiving electronic prescription, secure messaging between patient and the doctor, protected health information sharing, health information exchange integration, ICD 10 integration, smart device integration, Electronic Medical Records capability, Drug name and strength integration, insurance eligibility and claim and a lot more. With our proprietary technology, patients can send their real-time EKG, blood pressure and temperature to the doctor. No other health technology platform is currently providing such diverse features. There are two applications – DocVilla and DocVilla Doctor available on iOS and Android app store. DocVilla application is for the patients and DocVilla Doctor is used by the state-licensed Doctors. For more details please visit our website .

Initial assessment by physicians

DocVilla can help the patients get access to Physicians using telemedicine. Patients do not even have to leave from home and can get answers to their questions from the comfort for their home.

Counselling by Psychiatrists

COVID 19 has created fear and paranoia among people. Patients can get access to Psychiatrists, Psychologists and Counsellors using the platform. The president recently relaxed the rules for telehealth where the doctors can help the patients across United States. This helps the patients in discreetly getting access to more doctors across the US.

What is DocVilla doing to help the community?

We are waiving any monthly fee from the providers (Physicians, NPs and Psychiatrists) who can help the COVID 19 patients for a limited time.

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