We therefore offered follow-up through a short message service (SMS) to all confirmed positive outpatients and discharged patients from 21 March. Physicians from the IDD developed the SMS tracking platform in collaboration with the Information Technology Department of the Nîmes University Hospital, France. All confirmed patients were called by an IDD physician who relayed the result of the RT-PCR test, explained hygiene and isolation instructions and offered inclusion in the SMS tracking platform. Consenting patients were included in the platform and follow-up started the following day for 14 days.
Every morning at 08:45, patients received the following questions:
“You’re being followed for COVID-19. As agreed, please answer these 4 questions, if possible before 10:30 am. Are you ready? If so, send [1]”.”
“Question 1: Has your condition worsened since yesterday? (No (Send [1]), Moderately (Send [2]), A lot (Send [3])).
Question 2: Do you have trouble breathing? (No (Send [1]), Moderately (Send [2]), Very much, while doing very little (Send [3]))
Question 3: Can you easily manage your daily life (washing, dressing, and eating)? (Yes (Send [1]), No, not at all (Send [2]))
Question 4: Do you feel able to continue home confinement? (Yes (Send [1]), No, not at all (Send [2]))
Questions were chosen to be easily understandable and to cover the different aspects of COVID-19 symptoms and the related isolation (clinical, psychological and practical). The questionnaire took less than 5 min per day to complete.
An automated reminder was sent if no response was received by 12:00. The tracking platform generated a web page with each row representing a patient integrated in a separate dashboard distinct from patients’ medical chart. Daily responses were converted to green, orange or red trees, analysed daily in real time from 08:00 to 20:00. One infectious diseases physician dedicated 50% of their working hours to the inclusion of patients, colour checking and contacting the orange/red patients.
Patients with only “1” responses were displayed in green and received the following message: “Thank you for participating. Your condition is stable or improving. Follow-up continues at home. Continue to adhere to strict containment guidelines. See you tomorrow.”
If there was at least one “2” response but no “3”, patients were displayed in orange and the following message was sent: “Thank you for participating. It seems to us that your condition requires re-evaluation by your general practitioner today to continue follow-up at home. Please continue to adhere to the strict containment guidelines. See you tomorrow.”
If there was at least one “3” response, patients were displayed in red and the following message was sent: “Please dial 15 [emergency medical assistance service] promptly so that your condition can be assessed by an emergency and/or infectious diseases specialist.”
“Red” patients were called immediately to check the patient’s condition and organise transfer to hospital if needed. “Orange” patients were called within 2 h to see if the specific instructions following the SMS had been followed.
We were rapidly able to offer the inclusion of patients into the tracking platform to nine other ambulatory COVID-19 centres in the Gard department: two secondary general hospitals and seven general practitioner groups caring for suspected and confirmed COVID-19 patients.
General practitioners were informed of the existence of the SMS tracking system and how to join via e-mail from the ARS (Regional Health Agency).