*5.2. Telemedical Solutions during the Covid-19*

Despite the many telemedical options available on the market that could offload hospitals and medical staff during the Covid-19 pandemic crisis, which dramatically hit many healthcare systems, especially in Italy, causing more than 24,000 deaths, there was no advocacy for using available telemedicine to provide continuity of care solutions for the chronically ill [39]. The only telemedical method used was a smartphone application for contact tracing. However, in a lockdown situation, an increase in the use of home telemonitoring systems to monitor vital signs was observed, which helped about half of the patients with chronic diseases to adjust the appropriate treatment [53]. Implemented remote patient-monitoring initiatives, such as Telehealth Intervention Programs for Seniors, that provide a weekly assessment of vital signs for low-income older people, can be an example of a successful program that reduces the number of hospital visits among older people [54].

One of the interesting telemedical solutions used in China during the Covid-19 pandemic was a mobile telehealth system, which was used to facilitate the presentation and discussion on the case study. This could help prevent the mobility of doctors in the hospital for consultation and decrease person-to-person contact to reduce the risk of transmission of infection between healthcare professionals [55].

According to the literature, the smartphone can be used as an adaptive physical activity smartphone intervention using a unique application supporting its positive effect on physical activity and a sedentary lifestyle [56]. However, during a pandemic and lockdown policy, smartphones do not seem to be such a useful tool to monitor the level of human activity because users do not wear them all the time at home.

The Covid-19 pandemic also had a significant impact on mental health. Isolation, social distancing, job loss, workload, and high exposure to coronavirus among healthcare professionals could lead to psychological distress and many adverse effects on mental health, including depressive symptoms, anxiety, burnout, and exacerbation of mental illness [57]. Telemental health services such as counseling, supervision, training, and psychoeducation via online platforms could provide adequate support to patients, family members, and health service providers during a pandemic [57].

### *5.3. The Post-Covid-19 Face of Telemedical Services*

The pandemic redefined the use of primary care, healthcare services and the physical examination process. In the absence of data from physical examinations, the only source of information about the general health of the patient were smartwatches and home medical devices. We hypothesize that a novel category of medical devices is being introduced—a smartwatch or medical wearable device (certified in accordance with Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, PN-EN ISO 13485:2016 standards), which will focus on recording overall health on the basis of available data, which can be accurately recorded by wearable device sensors (e.g., smartwatch). These categories of devices may redefine the way primary care is delivered because physical examination can progress to remote examination, supported by data from a certified wearable medical device, which can improve diagnostic decisions and screening. The smartwatch already has the ability to synchronize health data with the cloud service, which allows easy remote sharing of health data with a primary care physician without additional cloud infrastructure. This allows for fast deployment of telemedical services based on wearable devices and scalability of solutions. Evaluation of the clinical effectiveness of wearable medical devices and mindset change of both healthcare professionals and patients are among important challenges in the adoption of wearable telemedical services. However, consideration should be given to ensuring the confidentiality, integrity, and security of sensitive medical data so as to prevent access by unauthorized persons. Other challenges include ensuring interoperability and supervision over the place where medical data is stored, along with compliance with related regulations and standards. Furthermore, there are wearable devices that are certified as medical devices

and are FDA-approved for certain health indications, such as the Apple Watch and the Omron Health Guide Watch [58].

### **6. Conclusions**

We presented a developed and validated methodology that we used to assess cardiovascular and pre-frailty risk during the Covid-19 shelter-in-place measures on human activity patterns based on multimodal biomarkers collected from smartwatch sensors. The developed method can be easily deployed in the software update of the smartwatches or other wearable devices and might be a useful health screening metric. We believe that in the future, smartwatches or novel wearable medical devices may play an essential role in telemedical services, especially during emergency scenarios or health crisis. However, the impact of long isolation on health is unknown and will be the subject of future research. Future research will also focus on human aspects during shelter-in-place measures. Our findings may be useful to policymakers and can be used to find solutions to support people, especially older adults, during the lockdown period and improve the quality of telemedical services.

**Author Contributions:** Conceptualization, E.K. and A.K. (clinical part); Data assessment, E.K.; Data processing, E.K. and A.K.; Analysis and interpretation, E.K. and A.K.; Writing—Original Draft Preparation, E.K. (lead) and A.K. Writing—Review & Editing, E.K.; A.K. Supervision, E.K.; Funding Acquisition, E.K. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research was funded by AGH University of Science and Technology in 2019 as research project No. 16.16.120.773.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki, ethical review and approval were waived for this study, due to University guidelines for noninvasive retrospective studies.

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** The data presented in this study are available on request from the corresponding author.

**Acknowledgments:** Authors thank the anonymous reviewers for their valuable comments regarding the improvement of this manuscript.

**Conflicts of Interest:** The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.
