Could Covid-19 unleash new frontiers in care?

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by Godwin Nnanna

As new cases of coronavirus are reported across the United States, many are livid. Very few aspects of American life, if any, remain unaffected. For the first time in its 258-year-old history, New York City’s Saint Patrick Day parade won’t hold today as previously planned.

Not even during the first and second world wars did the city cancel the parade. Held along the city’s Fifth Avenue since 1762, the parade draws some two million spectators and revelers. Another 150,000 march in the parade.

Today, the city is a deserted place. The city that never sleeps looks like a sleepy ghost town. “We are in a war,” says New York mayor, Bill de Blasio, who described the challenge the coronavirus poses as a mix between the 2008 financial crisis, the Great Depression of the 1920s, and the 1918 flu pandemic which killed about 50 million people.

As at Monday evening, there were 950 confirmed cases in New York alone, up from less than 400 two days prior. Blasio has told residents not to leave their homes unless absolutely necessary. “Our lives are all changing in ways that were unimaginable just a
week ago. The truth is that this is not a banal flu,” Blasio said.

The rush to close

The mayor signed an executive order this morning limiting restaurants, bars and cafes to food take-out and delivery. Blasio says, “our city is facing an unprecedented threat, and we must respond with a wartime mentality.” The mayor called for a robust response to the coronavirus outbreak, including help from the US military and a nationalized supply chain and says a ‘full-war footing’ is necessary to save as many as possible. New York governor, Andrew Cuomo has ordered all local governments in the state to limit their workforce to 50 percent capacity and directed state agencies across the state to also have ‘non-essential’ employees work from home.
Companies are asking staff to work from home. The tech companies are leading the way.

Facebook, Google, Twitter and Amazon have implemented remote working policies for many or all of their employees around the globe. Google instructed all its employees in North America, Europe, Africa and the Middle East to work remotely. JPMorgan Chase and Citigroup conveyed same directive to all staff “who can”. This is only for employees who have roles that can be performed from home,” JPMorgan noted in an internal memo.

Can everybody work from home? Are there innovative ways to make even some of those on essential services work remotely. Can medical doctors work from a distance without the conventional face-to- face experience? When a patient needs an emergency procedure, every minute count. Through the integration of technology and peer consultant outreach, hospitals are developing some novel approach that can address situation‐specific challenges to care; such challenges as the spread of the coronavirus present today.

New frontiers
The Mass General Center for Telehealth in Boston aims to provide high-quality, coordinated care to patients and families through virtual technology. The Center consists of a diverse team of care providers, and clinical and administrative personnel committed to enhancing patient care through telehealth services.

Center Director, Lee Schwamm, believes telehealth offers unique capacity for remote screening, triage, and treatment at times of heightened infection concerns – like Covid-19 presents – and it could be a powerful tool for reducing transmission of the disease to and among healthcare workers and patients who are not infected.

“Given the situation, with the concept of social distancing, keeping people away from clinics, we want to keep them at home to keep them healthy,” says Neal Sikka, Associate Professor of Emergency Medicine at George Washington University.

Sikka told CNN that the GWU Hospital “plans to use its virtual option to provide doctor guidance on coronavirus symptoms and questions” and “to serve more of its regular daily patients through telehealth to let them remain protected at home.”

As health analyst Christina Farr writes “coronavirus could be a boon for telemedicine, as health industry hopes to keep ‘worried well’ out of the hospital.”

“To unveil how telemedicine can be helpful under the circumstance is to answer the question – what happens when we meet the doctor face-to-face,” says Dr Victor Boderinwa, a Nigerian-American anesthesiologist based in Baltimore. “Much of the interface in our regular interaction with the doctor, could be done virtually with the right deployment of technology. On a whole broad new level, that’s the future telehealth is exploring. It’s a future relevant now than ever,” Boderinwa says.

Hospitals without beds
One growing concern emerging from the rapid spread of the coronavirus in healthcare circles today, is what happens if the spread overwhelms the nation’s hospitals. “When you look at the projections, there’s every chance that we could be Italy,” U.S. Surgeon General Jerome Adams told Fox News on Monday.

Overwhelming conditions where cases have outpaced the number of beds in hospitals, is the severe condition Italy has found itself in the last week. Some experts warn that the US might be heading that way if the virus continues on the present pace.Some experts now think one way to mitigate the likely dilemma of such surge is to explore the possibility of treatments from distance.

This, they insist, is already happening in rural America where recent consolidations have seen more hospital closures. According to a Government Accountability Office (GAO) report in 2018, 64 rural hospitals closed in America between 2013 and 2017, a figure which
represents twice the number or rural closures in the previous five-year period.

In some of these communities, programs in telehealth are helping improve access to care.
According to Dr. Christopher Caggiano of the George Washington University School of Medicine and Health Sciences, in a pilot program with the Veteran Health Association (VHA) where 900 patients used home telehealth services between 2000 and 2003 resulted in a 40% reduction in emergency room visits, a 63% drop in hospital admissions and an 88% decrease in nursing home bed days of care.

“The VHA estimated the cost per patient in the telehealth program to be about $1,600 per year, which is significantly less than the $13,121 average annual direct cost per patient for the traditional home-based primary care.”

Unleashing telemedicine
Given the emphasis on social distancing while the coronavirus pandemic lasts and the need to prevent hospitals from being inundated with patients not related to Covid-19, interest in telemedicine has witness a huge spike. The Trump administration today announced an unprecedented expansion of telehealth services for seniors. “Medicare patients can now visit any doctor by phone or videoconference at no additional cost, including with commonly used services like FaceTime and Skype,”

Trump said during a White House press briefing. “A historic breakthrough — this has not been done before.” “In addition, states have the authority to cover telehealth services for their medical patients, Trump said. “And by doing this, the patient is not seeing the doctor per se, but they’re seeing the doctor, so there’s no getting close.”

“Medicare beneficiaries across the nation, no matter where they live, will now be able to receive a wide range of services via telehealth without ever having to leave home,” said Seema Verma, the head of the Centers for Medicare and Medicaid Services. “And these services can also be provided in a variety of settings, including nursing homes, hospital outpatient departments, and more.”

 

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