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Practice
Establishing and operating a ‘virtual ward’ system to provide care for patients with COVID-19 at home: experience from The Gambia
  1. Oghenebrume Wariri1,
  2. Uduak Okomo1,
  3. Carla Cerami2,
  4. Emmanuel Okoh3,
  5. Francis Oko1,
  6. Hawanatu Jah3,
  7. Kalifa Bojang3,
  8. Bubacarr Susso4,
  9. Yekini Olatunji3,
  10. Esin Nkereuwem1,
  11. Fatai Momodou Akemokwe4,
  12. Modou Jobe2,
  13. Orighomisan Freda Agboghoroma4,
  14. Bunja Kebbeh4,
  15. Ghata Sowe1,
  16. Thomas Gilleh5,
  17. Naffie Jobe6,
  18. Effua Usuf3,
  19. Ed Clarke1,
  20. Helen Brotherton3,7,
  21. Karen Forrest4
  1. 1Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
  2. 2Nutrition Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
  3. 3Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
  4. 4Clinical Services Department, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
  5. 5Data Management and Archives, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
  6. 6Directorate, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
  7. 7Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Oghenebrume Wariri; owariri{at}mrc.gm

Abstract

Health systems in sub-Saharan Africa have remained overstretched from dealing with endemic diseases, which limit their capacity to absorb additional stress from new and emerging infectious diseases. Against this backdrop, the rapidly evolving COVID-19 pandemic presented an additional challenge of insufficient hospital beds and human resource for health needed to deliver hospital-based COVID-19 care. Emerging evidence from high-income countries suggests that a ‘virtual ward’ (VW) system can provide adequate home-based care for selected patients with COVID-19, thereby reducing the need for admissions and mitigate additional stress on hospital beds. We established a VW at the Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, a biomedical research institution located in The Gambia, a low-income west African country, to care for members of staff and their families infected with COVID-19. In this practice paper, we share our experience focusing on the key components of the system, how it was set up and successfully operated to support patients with COVID-19 in non-hospital settings. We describe the composition of the multidisciplinary team operating the VW, how we developed clinical standard operating procedures, how clinical oversight is provided and the use of teleconsultation and data capture systems to successfully drive the process. We demonstrate that using a VW to provide an additional level of support for patients with COVID-19 at home is feasible in a low-income country in sub-Saharan Africa. We believe that other low-income or resource-constrained settings can adopt and contextualise the processes described in this practice paper to provide additional support for patients with COVID-19 in non-hospital settings.

  • COVID-19
  • control strategies
  • health systems

Data availability statement

There are no data in this work.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjgh-2021-005883

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    Data availability statement

    There are no data in this work.

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    Footnotes

    • Handling editor Seye Abimbola

    • Twitter @drwariri

    • Contributors All named authors made substantial contributions to establishing/operating the virtual ward (VW), or the conceptualisation of the practice paper, or the drafting of the manuscript, and critically reviewing the manuscript. OW led the implementation and coordination of the VW during the first wave of COVID-19 in the Gambia and conceptualised the idea for this practice paper. All authors approved the final version and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The work reported here was supported by funding from the European Commission (reference number: FED/2020/417-470) through the ‘Support and strengthen the public health and socioeconomic systems to reduce the impact of the Covid-19 pandemic in The Gambia’. HB was supported by Wellcome Trust (reference number: 200116/Z/15/Z) as a clinical COVID-19 secondment. The funder had no role in the design or the reporting of this work.

    • Disclaimer The views expressed in this practice paper are those of the authors and do not necessarily reflect those of their parent organisation: The Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.