key: cord-0972330-hr5qy5g6 authors: Zhao, Yuanyuan; Wei, Lai; Liu, Bin; Du, Dunfeng title: Management of Transplant Patients outside Hospital during COVID‐19 Epidemic: a Chinese Experience date: 2020-05-14 journal: Transpl Infect Dis DOI: 10.1111/tid.13327 sha: c85a1f4a2f3e3aa82cd0123ede73d9d82bfe9dcb doc_id: 972330 cord_uid: hr5qy5g6 Coronavirus disease 2019 (COVID‐19) pandemic poses an increasing challenge for transplant community. Aggressive management measures are conductive to improve compliance and to lower the risk of intra‐hospital infection. In this Personal Viewpoint essay, we shared experiences about management strategies of transplant patients outside hospital amid the epidemic. With the aid of Cloud Clinic service and telemedicine care, transplant patients could be regularly followed up and get medical consultation online. Furthermore, personal health education and mental health assistance are enrolled in our practice. Coronavirus disease 2019 (COVID-19) pandemic sweeps across the globe. SRAS-CoV-2, the causative agent of COVID-19, is more infectious than SARS-CoV and MERS-CoV [1, 2] . Hubei Province is the largest area affected by COVID-19, and meanwhile, Hubei province is widely regarded as the cradle of transplantation in China, in which over 1,550 kidney transplant and 400 liver transplant surgery are performed per year. Impairment of immunity could increase incidence of opportunistic infections [3, 4] . Transplant patients receive regular follow up in outpatient clinic, in which they might have epidemiological exposure to infected patients or asymptomatic individuals in incubation period and meet intra-hospital transmission during the outbreak [5] . In addition, transplant patients are usually accompanied with underlying diseases such as hypertension or diabetes, which are prone to critical outcome of COVID-19 [6] . In this Personal Viewpoint essay, with the aid of Cloud Clinic service and telemedicine care, we conducted aggressive management of transplant patients outside hospital amid COVID-19 epidemic. We succeeded in improving compliance of patients and lowering the risk of nosocomial infection. Online telemedicine is highly efficient in remote follow-up of chronic diseases, cancers, and even badly great natural disaster [7] [8] [9] , and could offer significant advantages in both price and convenience [10] . During the epidemic outbreak, lock down and restriction policies implemented by This article is protected by copyright. All rights reserved the government of Hubei province made it difficult for outpatient visits. Meanwhile, intra-hospital spread of COVID-19 evolved quickly. Online telemedicine has an edge in "no touch, and no cluster". Therefore, it is rewarding that outpatient visits move from hospital outpatient clinic to online clinic. To this end, our center launched "Cloud Clinic" service from early February, 2020, the peak period of COVID-19 outbreak in Hubei province. The flowchart of Cloud Clinic service was showed in Figure 1 . Briefly, after registration, patients could access to Cloud Clinic service via chat or via video, then choose an in-network doctor or an in-network psychological expert. workers to patients' home on occasion to take blood samples, and the results will be responded to associated doctors. Every patient has an independent and exclusive medical card which was established by hospital, and doctors can browse all the past test results and assess whether the patient needs to be hospitalized. In our practice, we have implemented 2460 person-times of online telemedicine care for transplant patients amid the epidemic from Feb. 10, 2020 to Apr. 10, 2020. Among them, a total of 53 cases required hospitalization. The demographic characteristics and outcome of these 53 cases were showed in Table 1 . Notably, 14 cases were diagnosed with SARS-CoV-2 infection and were admitted into the designated hospitals. Twelve were renal recipients, and 2 liver recipients. These This article is protected by copyright. All rights reserved patient died. The biological features and kinetic changes of SARS-CoV-2 are not fully recognized, and asymptomatic carriers with normal chest computed tomography (CT) findings are also infectious [11] . It was reported that of the 6 family members who travelled to Wuhan, 5 were identified as COVID-19 [12] , which showed high risk of family cluster. Hence, personal health protection should be concerned. Our Cloud Clinic released videos of public health education, in which hand hygiene and personal protection equipment had been notified as core strategies in the prevention of infection, and patients could access to them for free. We advised patients to stay at home during epidemic outbreak in order to decline the incidence of exposure. Furthermore, diary temperature monitoring, disinfection, and food nutrition are recommended. COVID-19 epidemic has aroused increasing attention nationwide. Both patients and healthcare workers are amid insurmountable psychological pressure [13] . Previous studies revealed that depression increased mortality rate post-transplant [14] . Therefore, screening and intervention on mental health problems are essential for transplant patients. We performed a cross-sectional study to evaluate the physical and mental status of post-transplant patients. A total of 492 recipients who resided in Wuhan attended telephonic interview during the period of epidemic outbreak. The results showed that 81.1% (n=399) of them had varying degrees of negative emotions such as fear (69.7%), difficulty falling asleep (19.3%), and depression (11.0%). It implied that mental health crisis was ubiquitous in transplant population. They not only worried about being infected by SARS-CoV-2, but also worried about the side-effects of delaying hospital visits. Unreasonable immunosuppressive therapy could increase the incidence of infection or rejection [15, 16] . Of 399 patients who had negative emotions, 67.2% (n=268) worried about these. In addition, 20.8% (n=83) thought that they would be susceptible population for SARS-CoV-2 infection due to long-term immunosuppression. One-to-one mental health crisis assistance is provided in Cloud Clinic service. Patients are encouraged to actively adjust their emotions, to present positive attitude, and to do exercise properly. This article is protected by copyright. All rights reserved The COVID-19 epidemic is undoubtedly a serious disaster. We launched "Cloud Clinic" service to take online telemedicine care instead of traditional outpatient visits for transplant patients. This measure could availably improve the patients' compliance and lower the risk of intra-hospital transmission of COVID-19. We could remotely monitor the clinical course of COVID-19 and make therapeutic strategies for infected patients through online MDT management program. Meanwhile, we implemented online public health education and mental health assistance for patients, which may be conductive to recovering from psychological crisis during the epidemic. 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All rights reserved measures in patients with chronic kidney disease: the PROKID study -study protocol for a non-inferiority pragmatic randomised controlled trial Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland University of Texas Medical Branch telemedicine disaster response and recovery: lessons learned from hurricane Ike Presumed Asymptomatic Carrier Transmission of COVID-19 A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster Progression of Mental Health Services during the COVID-19 Outbreak in China Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation: A Systematic Review and Meta-Analysis Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study Risk factors for BK virus infection and BK virus-associated nephropathy under the impact of intensive monitoring and pre-emptive immunosuppression reduction This article is protected by copyright. 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