Coronavirus disease 2019 (COVID-19) is cau sed by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), a novel coro navirus first identified in Wuhan, Hubei Province (China), in December 2019¹. The first case in the municipality of Posadas (the capital of Misiones Province, Argentina), was detected on 27 March 2020. Approximately 30% of the population of Misiones resides in this city, and the vast ma jority of workers have health coverage provided through the Social Security Institute (Instituto de Previsión Social, IPS)². In Misiones Province, it is considered that the spread of the virus has been mediated by the proximity of the borders with Brazil and Paraguay, as well as by domestic mo vements between Misiones and the province of Corrientes, with high viral transit and/or close contact with people infected by SARS-CoV-2.

Outpatient monitoring is a critically impor tant measure in patients with COVID-19, recom mended by international organizations and the National Ministry of Health³. Monitoring of patients with COVID-19 reduces the risk of adverse outcomes, including hospitalizations and mor tality³. The IPS created the Home Follow-up Ser vice for patients in May 2020 in order to provide clinical indications for self-care to outpatients with COVID-19 and to enable health providers to distinguish between clinical forms that can be followed on an ambulatory basis from severe forms requiring hospitalization. Information is available on the clinical characteristics and di sease course in hospitalized patients in Argen tina^4-6. There is several international literatures about management of patients with COVID-19 at home with telehealth, so there is a systema tic review by Khoshrounejad et al.⁷ analyzing the telehealth-based services during the COVID-19 pandemic. The authors reviewed 5005 studies of which 64 (from 18 countries) were selected.

This study aims to describe epidemiological and clinical characteristics, the disease course, and the hospitalization rate in patients with COVID-19 using the IPS home follow-up service from 1 January to 31 March 2021. It included pa tients with a diagnosis of COVID-19 in line with official Ministry of Health guidelines, that is, (1) by laboratory confirmation with either PCR de tection of the viral genome or antigen testing, or (2) according to the criteria for defining a suspec ted case: “close contact with a confirmed case of COVID-19, who, within 14 days of contact, pre sents symptoms as determined by protocol”¹.

The clinical assessment data were collected by a group of primary health care physicians affiliated with the IPS and specialists in diag nostic imaging who were responsible for eva luating and analyzing the epidemiological and clinical variables of interest. The study inclu ded patients covered by the IPS who agreed to participate and gave their informed consent by telephone and/or video consultation and who requested telephone or home follow-up for CO VID-19, with the following symptoms: (1) fever and uncomplicated illness (self-perceived local symptoms in the upper respiratory tract, with or without non-specific symptoms such as mus cle pain or atypical symptoms in the elderly); (2) mild pneumonia: (confirmed with chest X-ray and without signs of severity); alveolar oxygen saturation (SaO₂) > 90% in room air; CURB-65 ≤1 (British Thoracic Society); or (3) severe pneumo nia, failure of ≥ 1 organ, SaO₂ < 90% in room air, or respiratory rate of ≥ 30.

Patients underwent an initial clinical consul tation by video or telephone, and the variables were collected. The attending physician deter mined the need for home follow-up, in line with protocols for self-isolation and the loan of pulse oximeters for home use. The intervention moda lity included video consultations and/or home visits by a professional with appropriate perso nal protective equipment⁸. Home visits were ca rried out according to professional criteria and the severity of each case. The Bioethics Commit tee of the Hospital Escuela de Agudos Dr. Ramón Madariaga of the Ministry of Public Health of the Government of Misiones approved the study.

A total of 72 patients were included; their demographic and clinical characteristics are shown in Table 1. Thirty-eight patients were over 65 years of age, and among this age group, 7 (10%) patients presented respiratory distress, which was monitored using pulse oximeters. Pa tients with uncomplicated disease were symp tomatic for a mean period of 5.3 days (SD 2.1); patients with mild pneumonia, 6.9 days (SD 3.1); and those with severe pneumonia, 8.0 days (SD 2.5) (p<0.005). The mean age in patients with uncomplicated disease (57.3 years), mild pneu monia (52.9 years), and severe pneumonia (56.9 years) were not similar (p=0.078). Patients aged 65 years and older (38) constituted 53% of the cases (mean age 72.9 years, SD 5.7). They presen ted low oxygen saturation: 92% to 94% in 7 pa tients (10%), and <92% in 3 (4%). Older patients also had a longer symptomatic period (mean 6.5 days, SD 3.0). Five of the 72 patients were hos pitalized due to COVID-19 (6.9%, 95% CI 2.6 to 16.1). The main criterion for admission was SaO₂ of less than 90%, as measured with the pulse oximeters delivered to the patient’s homes. All patients that required hospitalization were over 65 years old (13.2% [5/38] vs. 0% [0/32], p=0.05). In general, admission was associated with co morbidities related to bacterial pneumonia and in patients with stroke sequelae and chronic obstructive pulmonary disease. Four hospitali zed patients had an average length of stay of 8 days, with no need for mechanical ventilation, and one patient died. The patient who died was a 76-year-old man with heart failure as a comor bidity.

Table 1 Characteristics of included patients (n = 72) 

At the level of primary health care, the main intervention in the management and treatment of COVID-19, apart from clinical care itself, is the discrimination between cases with comorbidities or with an unfavorable evolution, such as mild pneumonia, that can be managed in an outpatient or home setting versus cases likely to develop severe pneumonia or respiratory dis tress. The community use of the pulse oximeter and telemedicine tools could help predict the di sease course, with greater possibilities for self-management, than complementary laboratory studies^9,10.

In conclusion, the telemedicine, including video consultation and home monitoring of pa tients from the IPS, was a proper intervention for the management and treatment of COVID-19 in Misiones. This intervention has been accessi ble and cost/benefit effective.