How teleradiology can help public health COVID-19 management

by Guillaume Gorincour, Amandine Crombé, Mylène Seux, Hubert Nivet, Vivien Thomson (g.gorincour@imadis.fr)

Coronavirus Disease 19 (COVID-19) crisis has highlighted the urgent need for reliable and rapid tools to monitor, ideally in real time, the dynamics of the pandemic. These data enable to adapt public health measures as closely as possible and to measure the effectiveness of lockdown and other actions to limit the viral spread.

The current tools used by the Administrations require significant human and Information Technology (IT) resources that can vary from one territory to another, even within a same country. Indeed, the computer systems from public hospitals, private clinics and practitioners, or institutions for elderly people are very diverse and not always interoperable. In France, for example, since the beginning of 2020, “Santé Publique France” (SPF) had the crucial mission to monitor, understand, and limit the COVID crisis on the national territory. The work of SPF is based on epidemiological analyses of COVID-19 surveillance data from several sources: numbers of teleconsultations (Réseau Sentinelles, SOS Médecins), lab tests (Centres nationaux de reference CNR, Eurofins-Biomnis, Cerba) and hospital, patients hospitalized in intensive care units (Système d’information des victimes SI-VIC, Services Sentinelles de Réanimation / soins intensifs SSR), patients in emergency department (Oscour), deaths (SI-VIC, SEMS, Insee, CépiDc). Besides, the monitoring of diverse other data collected by regional health agencies helps SPF reinforce the essential coordination for crisis management [1, 2].

Teleradiology uses homogeneous IT tools within the partner structures, and many companies organized themselves to monitor chest CT-scans carried out as part of the initial or follow-up care of patients suspected or confirmed to have COVID-19 [3], to develop practical models to facilitate COVID-19 diagnosis [4] and to monitor the impact of lockdown on the management of emergencies outside COVID [5]. These IT tools enable a real-time audit of sectorized activities, in our case since the first French lockdown in March 2020. It appears that our COVID activity curve including 85 partner hospitals in France (Fig. 1d) is exactly superimposed on the curve of French global data (Fig. 1a-c). Our partial imaging data can therefore be extrapolated to French population data and could offer SPF a real-time estimation of news hospitalizations awaiting thorough data collection.

Fig. 1: Evolution of COVID-19 curves in France. Temporal evolution of: (a) the number of new weekly COVID-19-related hospitalizations, (b) the number of new weekly COVID-19-related intensive healthcare unit (ICU) admissions, (c) and weekly COVID-19-related deaths in the hospitals, and (d) weekly percentage of teleradiology activity of the COVID-19 care pathway (i.e. number of CT-scans related to COVID-19 over the total number of CT-scans). The dashed lines correspond to the date of 1st and 2nd lockdown beginnings (2020-03-14 and 2020-10-30). The dotted lines correspond to the 3 dates of post-lockdown phases (2020-05-11, 2020-06-02 and 2020-06-22). (Source for a-c: Santé Publique France, https://www.data.gouv.fr/fr/datasets/donnees-hospitalieres-relatives-a-lepidemie-de-covid-19/) and of COVID-19 sector activity (d, % of CT performed for suspected COVID over total activity; source for d: Imadis Teleradiology)

If all the French teleradiology actors, or even those in each country in Europe, harmonized and shared their data, the concerned national sub-territory, country or world region would have a qualitative and real-time assessment tool to monitor more closely the effectiveness of preventive measures implemented by governments.

Acknowledgments
We would like to sincerely thank all our partner centers, and the support teams at Imadis Teleradiology and in particular Tiffany Desmurs.