The rapid spread of covid-19, and the fact that healthcare facilities could be sources of contagion, has focused attention on new models of care that avoid face-to-face contact between clinician and patient. There has been particular interest in video consultations, which are already being rolled out in many countries as part of national digital health strategies. 1 2 3 How appropriate are video consultations for dealing with the coronavirus crisis—and what are the challenges of scaling up this model at speed?

Randomised trials (most of which were underpowered) have shown that clinical consultations conducted through a video link tend to be associated with high satisfaction among patients and staff; no difference in disease progression; no substantial difference in service use; and lower transaction costs compared with traditional clinic based care. 4 5 6 7 However, almost all this evidence pertains to highly selected samples of hospital outpatients with chronic, stable conditions and is largely irrelevant to the current escalating situation involving patients with an acute and potentially serious illness.