If COVID-19 hasn’t made you want to chat with your doctor yet, it may soon. As more cases of the novel coronavirus are contracted, and more cases spread through communities, more answers are demanded from the health care system. "We may only be seeing the tip of the iceberg," Tedros Adhanom Ghebreyesus, director-general of the World Health Organization tweeted last month.
There’ve been some concerning instances of onward #2019nCoV spread from people with no travel history to 🇨🇳. The detection of a small number of cases may indicate more widespread transmission in other countries; in short, we may only be seeing the tip of the iceberg.— Tedros Adhanom Ghebreyesus (@DrTedros) February 9, 2020
As coronavirus continues to evolve, will the already bustling waiting rooms, urgent care centers and emergency rooms be safe to go to?
Until recently, when a person met the clinical criteria for COVID-19 they became a person under investigation (PUI). Their clinician sent their samples to the Centers for Disease Control and Prevention for testing, and they were managed accordingly. That definition was limited to very specific travel conditions that are now changing, making many more people eligible for testing. Fortunately, diagnostic testing is becoming available for clinicians to do in their own jurisdictions.
This improved access is great news for clinicians, but it doesn’t resolve whether coming in for testing will be safe for the other people that could get exposed. This is particularly important for people at higher risk for disease, such as the elderly and those with certain underlying health conditions.
Fortunately, the clinical world may already have a solution -- telehealth. The remote service is already used to improve health access and outcomes, according to WHO, which supports the use of telehealth. For COVID-19, telehealth can be a way to help fight the virus.
Telehealth would enable clinicians to triage potential PUIs without exposing health care workers or their communities to the virus. Beyond the benefits to the public, telehealth can also help individuals overcome barriers to getting to a clinician such as finding child care, taking off from work, using public transportation or getting to health care facilities from rural or remote areas. Crowded waiting rooms won’t need to be overrun with those anxious every time someone coughs or sneezes nearby. Crowded waiting rooms won’t need to be overrun with anxiety every time someone coughs or sneezes nearby. When an individual does fit the criteria, their clinician can instruct them how to come in for testing in the safest way.
Minimizing exposure could also lead to a “flattening of the curve” that COVID-19 is currently climbing.
Some type of legislation would be needed to cover the costs of expanding telehealth. Presently, Medicare Part B only covers certain telehealth services, and the federal Medicaid statute does not recognize telehealth as a distinct service. Telehealth is viewed as a cost-effective alternative but would require federally mandated coverage.
Some individual states already have telehealth laws in place, and others are fighting for them. Maryland state Sen. Clarence Lam, a physician by trade, believes strongly that "telehealth is fundamental for effective care as medicine progresses."
Acknowledging this need, congressional leaders just announced an emergency bill, the "Telehealth Services During Certain Emergency Periods Act of 2020." If approved, this bill could waive Medicare’s current geographical restrictions on telehealth, and expand telehealth’s reach. The bill carries a hefty price tag -- House Speaker Nancy Pelosi estimated it will cost nearly $500 million.
The cost for telehealth pales in comparison with the economic burden of COVID-19, which one finding placed at "$2.2 billion in public funding for prevention, preparedness and response" for coronavirus and "more than $3 billion to the development of treatments and a coronavirus vaccine."
Telehealth may end up being a critically important way to combat this outbreak, flatten the epidemic curve and help fight the virus' spread.
Delaram J. Taghipour, MD, MPH, MBA is a preventive medicine resident at Johns Hopkins Bloomberg School of Public Health and is a contributor to the ABC NEWS Medical Unit.