Coronataxi Brings Outpatient Care to COVID-19 Patients

To the Editor:

Our first patient treated in Heidelberg showed us how fast a formerly stable patient can rapidly deteriorate and need critical care. If deterioration happens in home quarantine, it can be fatal. This was an eye-opener about the need to monitor patients in home quarantine and identify patients at risk; thus, the coronataxi was born. To our knowledge, this approach is unique to Germany.

Under the guidance of the University Hospital Heidelberg and in cooperation with the regional health authorities, we built up a combination of a corona call center and the coronataxis, both staffed by medical students under the supervision of a physician. Patients who have had positive test results are called by the call center, and medical history, medication, and the current symptoms are assessed in a structured survey. In accordance with the results of the survey, a physician who is experienced in the care of coronavirus disease 2019 patients selects patients at risk of deterioration. These patients are visited by the coronataxis.

Each coronataxi is staffed with a driver as well as a nurse or a trained medical student. They obtain a focused standardized medical history; record oxygen saturation, pulse, and temperature; and obtain a blood sample. After these visits are completed, coronataxi medical staff report to the supervising physician, with special emphasis on patients with more severe illness. The physician then decides on the basis of the clinical presentation and the laboratory results whether these patients should be followed by the call center, should receive a follow-up visit by the coronataxi the next day, or should be admitted directly to the hospital. Since the start of the coronataxi service in March, we have visited approximately 400 patients at home, with 20 visits per day on average.

Our team visited a young woman who was so weak because of constant vomiting that we admitted her directly to the hospital. On the way to the hospital, she developed confusion because of severe dehydration. In contrast, an elderly woman with coronavirus disease 2019 and preexisting diabetes who was living with her son in quarantine was managed at home, although at the initial visit she presented with hypoglycemia. We also observed several older patients with obvious respiratory insufficiency who urgently needed inpatient care. These patients were discharged from critical care after recovery.

These cases show that patients of any age who have SARS-CoV-2 are likely to benefit from being closely followed with home visits. Furthermore, following coronavirus disease 2019 patients in a home setting as long as possible is important for their well-being and for conserving valuable hospital resources.

Our coronataxi service offers accessible contact with the health care system for patients in home quarantine, its objective being to avoid fatal outcomes. In addition, patients report that they are pleased by the support given by the corona team and are less anxious during their illness.