COVID-19 Resource Center

COVID-19 Resource Center

Disclosures: Healio Primary Care was unable to confirm the authors’ relevant financial disclosures at the time of publication.
November 15, 2021
3 min read

Automated text messaging service significantly improves outcomes in patients with COVID-19

Disclosures: Healio Primary Care was unable to confirm the authors’ relevant financial disclosures at the time of publication.
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact

Patients with COVID-19 who enrolled in an automated text messaging system with twice daily check-ins were 68% less likely to die than those who did not use it, according to an ACP press release.

The automated text messaging system called COVID Watch offered its users the ability to report intensifying symptoms at any time to a team of health care professionals, the press release said.

An infographic that reads: Compared with a usual care cohort, COVID Watch users had 1.8 fewer deaths per 1,000 patients at 30 days and 2.5 fewer deaths per 1,000 patients at 60 days.
Reference: Delgado MK, et al. Ann Intern Med. 2021;doi:10.7326/M2102019.

“At the start of the pandemic, when the world’s attention was focused on patients in ICUs and on ventilators, we recognized that for every patient with COVID-19 in an ICU, there might be 50 people with COVID-19 in the community,” M. Kit Delgado, MD, an assistant professor of emergency medicine and epidemiology at Penn Medicine, told Healio Primary Care. “Those patients were scared and also needed to be watched over because they could soon be one of those patients in an ICU or on a ventilator.”

Penn Medicine already had technology in place that allowed for automated messaging, saving the health system the initial time, money and staffing resources that would be needed to set up COVID Watch, according to Delgado.

He said this existing system was modified to send 3,488 patients “being managed as outpatients with COVID-19 or, in the early days when testing was less available, presumed COVID-19” who agreed to participate in COVID Watch. The system sent an automated text message two times a day that asked users “How are you feeling compared to 12 hours ago: better, same, or worse?’” Those patients who answered “worse” were then asked “Is it harder than usual for you to breathe: yes or no?” If a patient answered yes, the system sent an alert to a health care professional to call the patient within 60 minutes. At any time, patients were told they could text “worse,” and a health care professional would call back.

Delgado said that COVID Watch was staffed by eight health care professionals, most of whom were unable to work in the hospital amid the pandemic because of their own immunocompromised state.

M. Kit Delgado

“So, this was also an opportunity to redeploy existing staff to contribute to health system-wide efforts to respond to the pandemic,” he said. “We monitored patients at the health system level. That approach provided consistency and efficiency. Importantly, this decreased the burdens on primary care clinicians and their office staff.”

Delgado and colleagues compared the health status of COVID Watch users with 4,377 patients with COVID-19 who received usual care between March 23, 2020, and Nov. 30, 2020. The mean age of all the patients in the study was 43.4 years, 40.1% were men and their mean BMI was 31.4 kg/m2. Most of the patients (39.1%) were Black. Among those with preexisting conditions, the most common were high BP (20.6%), hyperlipidemia (16.6%), diabetes and asthma (8.6% each).

The findings, published in Annals of Internal Medicine, indicated that at 30 days, the COVID Watch users had a lower likelihood of death (OR = 0.32; 95% CI, 0.12-0.72), with 1.8 fewer deaths for each 1,000 patients (95% CI, 0.5-3.1). At 60 days, the difference was 2.5 fewer deaths for each 1,000 patients (95% CI, 0.9-4). In addition, COVID Watch users had more telehealth encounters, ED visits, hospitalizations and earlier ED presentations than the usual care group (mean days sooner = 1.9; 95% CI, 0.9-2.9).

Delgado said his institution is now testing automated messaging systems for other clinical conditions.

In an invited editorial, Jamie Faro, PhD, and Sarah Cutrona, MD, PhD, both professors within the UMass Chan Medical School Population and Quantitative Health Science Department, noted that COVID Watch was implemented within 17 days of the first COVID-19 case being reported in Pennsylvania.

Faro and Cutrona said the findings reinforce the notion of how being prepared often makes a difference between life and death.

“Longstanding investments in clinical and electronic infrastructure contributed to system readiness,” they wrote. “Rapid decisions informed by implementation science led to effective action. Enrollees had more frequent telemedicine encounters, more frequent and earlier presentation to the emergency department and reduced mortality. In short, the system saved lives.”


Automated Texting System Saved Lives Weekly During First COVID Surge. Published Nov. 11, 2021. Accessed under embargo Nov. 11, 2021.

Cutrona S, Faro J. Ann Intern Med. 2021.

Delgado MK, et al. Ann Intern Med. 2021;doi:10.7326/M2102019.