The COVID-19 outbreak started in December 2019 in China, and spread throughout the
world as a big threat since then. On March 11th, the World Health Organization (WHO)
declared it a pandemic. In Brazil, the first case was diagnosed on February 26th on
a man that had recently returned to Brazil from Italy, and on March 13th, Brazil diagnosed
its first case of community infection. Followed by that, on March 20th, the Brazilian
Health Ministry intensified the national efforts to control and prevent the fast spread
of the disease, issuing ordinance under number 454,[1] which recommends social distancing measures. The elderly – specifically the population
over 60 years of age – were considered a group of risk, and were advised to limit
their activities to what are considered essential services and to avoid crowded spaces,
such as cultural and scientific events. In accordance with the national recommendation,
the state of São Paulo declared quarantine on March 24th, under decree number 6,4881.[2]
In this new national scenario, the Brazilian Federal Council of Medicine, through
official notice number 1,756/2020, issued on March 19th, communicated the Health Ministry
that it recognized the possibility and ethics of the use telemedicine, as an exception,
during the battle against the transmission of COVID-19, using teleorientation, telemonitoring
and teleinterconsult. On April 15th, the Federal Government enacted law number 13,989,[3] which regulates the use of telemedicine during the COVID-19 crisis as an emergency
measure. Moreover, the law defines telemedicine as medical practice mediated by technology
to promote health, research, patient care and prevention of diseases.
For decades, the Department of Obstetrics at Escola Paulista de Medicina, Universidade
Federal de São Paulo, has been promoting daily rounds. These meetings are held at
Hospital São Paulo, a tertiary service that is a reference in high-risk obstetrics
cases. All cases of patients hospitalized and cared for by the Obstetrics team are
discussed with professors, medical staff, residents and students – with almost twenty
people in the room per meeting.
With the advent of the pandemic, this model of rounds had to be significantly modified.
Numerous professors – particularly those most experienced – were advised to avoid
going to the hospital because they were older than 60 years of age. Therefore, our
department had to remodel its assistance and adequate it to the previously-discussed
legal terms. In this new model, the daily rounds are now held using the Google Meet
platform, and they are considered teleguidence or teleinterconsultation,[4] with the residents and medical staff providing care at the hospital, and the professors,
remotely from their residences. The decisions that are made during the meetings are
recorded in the electronic medical records of the patients by the residents, and,
simultaneously, one of the professors accesses the same records, remotely, from their
residence, to validate the decisions.
The social isolation imposed by the pandemic has stimulated the use of technology
as a fundamental tool not only in our context, but also around the world – as illustrated
in a recent editorial[5] about use of telemedicine in American universities. In our daily routine, it has
saved time previously used to commute to the hospital, lowered the consumption of
eletricity due to the lower use of the elevator, and lowered expenses with parking
tickets etc. Moreover, the virtual rounds broke geographical barriers and enabled
even more physicians in our department to participate, since it is now easier for
them to adjust their personal schedules to the schedule of the rounds. Therefore,
this new model enabled the dissemination of knowledge and experience beyond the University's
gates.
Our experience during this pandemic has shown that teleguidance and telesupervision
are possible. Moreover, if they are performed exchanging information through safe
virtual platforms, and if the notes on the medical records are inserted by residents
in-site and by the professors remotely, it is possible to guarantee privacy and co-responsibility
in medical assistance.
With the pandemic and subsequent social isolation, other activities that had been
previously suspended were resumed virtually. Now, scientific meetings with invited
guests, administrative meetings and academic classes have been made possible with
the use of technology. It is clear that telemedicine is viable and advisable for assistance
and educational purposes in Obstetrics, and that it should be used strictly according
to the regulation norms. In our service, this tool has enabled us to mantain a high
level of obstetric care, and we hope that future national laws make it possible for
us to use telemedicine after the COVID-19 crisis.
