The Covid-19 epidemic threatens to overwhelm the health care system. It is therefore essential to set up alternative solutions to hospital quarantine for all affected or suspected patients. In view of the urgency of the situation, it is necessary to imagine a new care pathway that would allow to relieve the hospitals, to avoid contaminations and to reserve beds for the most serious patients, while facilitating the work of the medical staff.

The Assistance Publique-Hôpitaux de Paris (AP-HP) and the software publisher Nouveal e-santé have launched a free application, called Covidom. Covidom. Intended for home medical monitoring of patients with or suspected of having Covid-19 who do not require hospitalization. It allows patients with or suspected of having Covid-19 without any sign of severity to benefit from remote monitoring at home via medical questionnaires offered once or several times a day, in addition to containment measures.

Concretely:

• the doctor includes the patient in the process (connection to the platform, registration of the patient by entering his administrative data and the useful medical data);
• the patient completes a simple digital questionnaire online on a daily basis, from a computer or via the application available on the main stores. The frequency of the questionnaire is variable depending on the risk stratification and the period;
• Depending on the response to the questionnaire, alerts can be generated. When necessary, for example in the event of high fever or significant respiratory discomfort reported by the patient, the care team is alerted and contacts the patient to adapt the follow-up and management if necessary. A remote medical monitoring center will be set up as of March 12 to monitor alerts for all patients included in Covidom.
• In case of immediate emergency, the patient is asked to contact the 15.

Lifen, a company specializing in the secure exchange of medical documents, has published an open source remote monitoring solution The project was initiated by Professor Philippe Ravaud, director of the clinical epidemiology center of the Hôtel-Dieu de Paris (AP-HP). In 3 days, Professor Philippe Ravaud's team of researchers worked together with Lifen's developers to co-build a remote monitoring platform for patients with COVID-19. Lifen proposes to monitor patients sent to quarantine at home thanks to an online self-evaluation questionnaire.

In order for infected patients to qualify for this remote monitoring, Lifen proposes that they be evaluated by a physician according to three criteria: "an absence of severe initial symptoms,their ability to remain in quarantine at home (i.e. their autonomy), andtheir ability to carry out remote monitoring (i.e. possession of and ability to use a smartphone). Patients receive an SMS at least once a day with a link to a self-assessment questionnaire. They have to answer less than 10 questions regarding their symptoms (temperature, breathing difficulties, pain) and their quarantine (their psychological state regarding quarantine and the disease as well as the people in contact with them during this period).

The Department of Infectious and Tropical Diseases (MIT) and the Information Systems Department (ISD) of the Montpellier University Hospital, for their part, have adapted the MHLink remote monitoring application (MHComm) to allow patients diagnosed with Covid-19 who do not have hospitalization criteria to remain at home while receiving personalized follow-up. After a consultation and screening, patients sent home to quarantine are monitored through the app if they choose. They have to fill in a daily questionnaire that measures the evolution of their health, can ask the care team their questions thanks to a secure messaging system, receive information and advice and keep a social link thanks to the team's listening skills, which helps fight against isolation. A medical and paramedical team is in charge of remote monitoring. It receives an alert if the patient has not filled in the questionnaire or according to the indicators resulting from the answers.

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