Most patients with COVID-19 are asked to self-isolate and monitor their symptoms at home. However, their conditions may decline rapidly and unpredictably. The authors studied the use of a remote patient monitoring service via text messaging with clinical support to facilitate emergency department and hospital care for patients who require it.

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To the Editor:We would like to thank Rahman et al 1 for their thoughtful review and discussion of our article "Letter: Operationalizing Global Neurosurgery Research in Neurosurgical Journals." 2As the authors described, increasing global neurosurgical capacity will undoubtedly require contributions from members of low-income and middle-income countries, yet numerous barriers stand in the way of entry to neurological surgery for trainees aspiring to a career in global neurosurgery. These obstacles include, but are not limited to, underfunding; paywalls; limited access to scientific literature in virtual form et/ou in physical copy; lackluster representation of research members from low-income and middle-income countries in landmark publications; and limited invitations to regional, continental, and international speaking engagements. The authors raise important points, and we believe a multipronged approach would accelerate desired outcomes for at-risk communities. Therefore, in addition to these proposed recommendations, we believe efforts, as previously described, 3,4 to further recruit from an untapped talent pool and increase capacity can be similarly used to equilibrate the current makeup of active neurotrauma groups globally. Importantly, diversity of thought and opinion can be supplemented by guidance and mentorship from established groups because the charge toward reducing the global burden of trauma to the nervous system and its coverings will also require a coordinated effort. Within organized neurosurgery, this effort could provide ongoing partnership facilitated by critical insight from established and trusted representatives of neurological surgery, including the American

To the Editor:We aimed to present additional considerations associated with dealing with the global burden of disease in resource-constrained settings. 1 Defined by the World Bank (2019) as having a Gross National Income (GNI) per capita of ≤US$995 and US$996 to $3895, respectively, low-and lower-to-middle-income countries (LMICs) bear the greatest burden of trauma globally, at approximately 70%. 2,3 The causes of traumatic brain injury (TBI) vary as well between high-income countries (HICs) and LMICs. HIC TBI typically affects older patients in the setting of vehicle accidents. 4 Meanwhile, in LMICs, young adults disproportionally suffer, owing to both vehicle accidents (cycling, motorcycling) and gunshot-related trauma, as seen in areas of conflict, including Central Africa, Central America, and the Middle East. 5 Neurosurgery in some LMICs has for long been considered "expensive and luxury," 6 further exacerbating access to care. 2,7 Increasingly, experts recognize the need for a neurotrauma literature that recognizes disparities between HICs, where many studies are published, 2,3,8 and LMICs, where the volume of pathology may be greater yet where scarcity of equipment, infrastructure, and staff prevails. 2,9 Though evidence-based guidelines emerging from leading institutions may set important recommendations that are distributed internationally, these protocols may be wholly impractical, if not unfeasible, in resource-constrained settings, which illustrates the importance of adapting protocols to locoregional circumstances.While each region faces its unique circumstances, there are broad realities that unite neurosurgical efforts in most LMICs. These include, but are not limited to, a higher frequency and greater severity of TBI in LMICs for demographic, economic, and political reasons, including road conditions, traffic safety laws, driver education; and the scarcity or unavailability of emergency transport services and cranial imaging modalities, critical care devices, including ventilators or intracranial pressure (ICP) measuring devices, specialized laboratory capabilities (blood banks, serum testing, eg, phenytoin levels, blood gas assays), disposable equipment (hemostatic agents, drains, catheters, and lines), and staff members trained in critical care management of cranial neurosurgery. Importantly, resilient, hand-operated, or non-software-based equipment may be more prevalent than equipment that is difficult to maintain such as electric or pneumatic drills, operating microscopes, and other digital devices.Elements of focus regarding TBI care in LMICs include the appropriate allocation of resources and equipment, collection of data from neurotrauma registries, increase in education on neurotrauma care, integration of teams within trauma-care centers, and increase in capacity. 1,10 Reports of clinical success from active neurotrauma groups in low-resource settings must supplement these efforts by sharing reproducible, safe, alternatives to "gold standard" benchmarks when they are not feasible for LMICs...