“Telemedicine in Saudi Arabia during COVID-19 pandemic” (Preprint)
Authors: Jameel Tahir , Baig Dr. Mukhtiar 
Published: July 2020

UNSTRUCTURED

The value of telemedicine (TM) is undeniable. However, in this pandemic situation, its worth has increased tremendously, and many countries are using it for their populations' awareness and consultation. The use of TM is not only cost-effective but also satisfies the needs of patients from any place at any time. This also reduces excessive visits to the hospital and thus saves the patient expenses. We are experiencing a once-a-lifetime experience of COVID-19, a global health emergency that has taken the whole world in surprise. In recent times, this is the first-ever infective emergency that has embraced each & every continent of the world with almost equal intensity [1]. Moreover, no one has a clear idea of the actual pathophysiology of the disease. The clinicians are becoming novice to expert as newer and newer developments are being experienced while managing the critically ill patients [2].
Telemedicine (TM) has the great potential of helping masses with health care emergencies like COVID-19. The essential approach to a suspected patient is first of all early clinical interviews to find out the presence or absence and gravity of cardinal symptoms, arranging the diagnostic testing and isolation of patients and monitoring of the close contacts of suspected patient [3]. Upon the availability of test results, a further set of actions is to be executed in both situations. Positive cases are isolated at home until they develop either breathlessness or other signs of impaired tissue oxygenation when they require admission to a hospital. In case of negative results, suspected patients need to be quarantined to monitor clinical progress. TM is of great value in all the above scenarios, especially if the video consultation facility is available [4]. It would reduce hospital consultation and lots of miseries of the patient. There is also an advantage of decreasing the chances of transmission of infection from patient to other patients suffering from different non-viral disorders.
Saudi Arabia (SA) experienced utilizing telemedicine services during the previous epidemic of the Middle East respiratory syndrome (MERS) is 2012 [5, 6]. Extensive fieldwork was carried out to establish the base work for this utility. During this pandemic, the Saudi health authorities consolidated all the efforts in a mechanized way. Saudi Telemedicine Unit of Excellence (STUE) was established to manage all the activities of the National Health Information Centres throughout the kingdom [7]. Along with all the other necessary actions to reduce the chances of getting infected or transmit the disease to citizens and foreign residents are living with or without families. The Ministry of Health (MOH) allocated a sufficient number of hospitals in each city dedicated to coronavirus patients. An extensive TM network was established in the whole country. Special telephone number i.e., 937, was advertised as telephonic helpline on Feb 29, 2020, WhatsApp consultations, twitter accounts, and Instagram IDs were made available for easy consultation [8, 9].
In the USA, TM services to patients are being provided by private companies on payments and free services provided by the health care systems. In SA, the telemedicine consultations are purely arranged by MOH and free [10]. Special arrangements are made for video consultations on Skype and Zoom. Patients and people undergoing quarantine and close contacts of the patients are liable to mental tension and depressive episodes. MOH SA arranged multiple psychiatric specialists to be available round the clock for any online consultation [11]. Regular SMS messages are being sent to all the residents and citizens, encouraging them to consult the online healthcare worker and specialist for any suspected symptom. The TM specialists have accompanied laboratory technologists; they are performing the tests of any suspected person at his residence [12]. A panel of specialists is available in multiple health awareness centers daily to be contacted by toll-free telephone numbers. MOH also has launched a mobile application "Mawid" for self-assessment exam & then easy availability of experts of TM without the need to call them. Patients have the facility of online video consultation through this application, and teams could reach the desired location for testing or moving the patient to the nearest hospital [13].
Telemedicine is helping patients other than COVID-19 as the general OPDs of the hospitals are suspended, and it's unlikely that they would be operational shortly. Follow category of patients are being provided online help of diagnosis, consultation, and admission in specialist units if required [7].
1.	Suspected acute infections
2.	Symptoms suggestive of cancers (Carcinoma, Sarcoma, and leukemias)
3.	Follow-up of chronic patients like diabetes, hypertension and renal impairment etc.
4.	Chemotherapy follow-up patients.
Utilization of Services: The services provided by the MOH received an overwhelming response from the citizens and residents of SA.
Use of various types of telemedicine services by the citizen [10,12]
Types	Numbers
Consultations on Mawid	176000/month
Phone calls	160,000/weeks
WhatsApps messages	3.7 million
Educational SMS	4 billion

The use of TM services and patient care are excellent and are being reflected by the SA lowest death rate in the world.
During this pandemic, people are scared and under lockdown, so they have disturbed social, mental, and psychological well-being [14]. Therefore, they need consultations for their psychological problems as well. In this regard, TM can play a pivotal role. We suggest that under-developed countries that do not have proper healthcare infrastructure, lack of qualified human resources, and other healthcare facilities to use the internet for TM.

References
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