‘Hello’ – the humble telephone re-emerges among the COVID-19 pandemic

Editor – I read with interest the paper by Hayes describing equipment needed to work from home in medicine.¹ I agree with the emphasis placed on the simple telephone over more hyped high-tech solutions which the NHS digital infrastructure was never pre-equipped with.

Recently, healthcare technology buzzed with artificial intelligence, big-data analytics, and increasingly advanced diagnostics. By March 2020, amid a global health crisis, most technological efforts were re-directed into countering COVID-19. Big-data-analytics were used to model viral activity and guide healthcare policy; deep-learning algorithms were developed to interpret diagnostic imaging; and apps for symptom surveillance and contact tracing deployed.² Most dramatically, there has been widespread adoption of telemedicine.³

In England, in February 2020 before COVID-19, the vast majority of primary care appointments (24 million) were conducted face-to-face (81%) with only a minority by telephone (14%) or online-video (<1%).⁴ However, data for March 2020 showed a significant shift from face-to-face (67%) towards telephone consults (28%). Data from NHS Digital for England shows the importance of telephone calls during the COVID-19 pandemic for primary care and for NHS 111/999 triage; the proportion of primary care appointments handled via telephone has doubled from 14% to 28% between February and March 2020. Remarkably, the shift has been towards simple telephone use rather than much vaunted online-video tools which remained at <1%. One possible reason is use of app or computer-based video services requires a degree of preparedness with these services already evaluated, installed, explained and available to users indiscriminately. Additionally, contacting vulnerable patient groups such as the elderly can be challenging via online-video services due to the more technical interface; and it also assumes widespread high-speed internet. Enter then, an old friend – the humble telephone – an easy-to-use 150-year-old technology found in almost everyone's home or pocket, familiar to young and old.

While telecommunications providers prepared for increased internet traffic, they did not expect an even greater surge in plain-old voice calls (up 35% in the USA as per Federal Communications Commission). Its dependability and ubiquity are the same reasons the phone-call remains the primary mode of contacting emergency services internationally. Indeed, between 18 March 2020 and 01 May 2020, the NHS in England triaged 533,236 phone-calls related to COVID-19 via its urgent 111 or emergency 999 numbers – arguably the telephone is still in its prime and is one of the understated heroes of the pandemic.⁴