Fighting the COVID-19 pandemic using the technology-based second-line in Italy and Lombardy: The urgent need of home-based remote monitoring systems to avoid the collapse of the hospital-centred first line

The Italian health system is quickly empowering the capacity of specific COVID-19 hospital admission (creating new COVID-19 emergency centres-hubs and new intensive care beds in the already existing hospitals) showing a great response in the first-line hospital-based treatment. The major aim of this brief viewpoint is to underline the underestimated role of second line home-based treatment (for positive or suspected patients isolated at home) that could avoid to overwhelm the first line, taking into account the contribution of the necessary social limitations-containment campaign. Particularly the condition of acute respiratory failure could be promptly detected for COVID-19 patients in home isolation without not necessary and potentially dangerous hospital accesses and checks, but using easy-to-use (also for elderly patients and caregivers), comfortable, low-cost, reliable remote monitoring devices, such as connected pulse oximeters that can send real-time vital signs and other key biomedical parameters (especially respiration and blood oxygen levels, body temperature and other parameters) to a hospital-based big data server-repository, where Artificial Intelligence algorithms-based interpretation systems can elaborate these clinical records alerting the physicians only when it is necessary (not too early and not too late) to evaluate if moving a patient from a second to a first line. The experience of biomedical engineering and informatics, strong in chronic care management, could functionally help clinicians in managing many patients and citizens during this strong and long pandemic. It is not possible to postpone the implementation of large remote monitoring programs providing digital devices centrally controlled. We hope that Italian and International scientific and clinical community could promptly introduce and strengthen this already available option. Further local actions are promptly needed, above all in Lombardy where the recent decades have seen the weakening of the patient-centered medical home for the benefit of the hospital-centred approach, not enough in case of epidemic.