The pandemic is reorganizing the concept of healthcare. Virtual health services (telehealth) are now being promoted across America. With advances in technology, face-to-face contact with our healthcare providers is not as necessary and at times risky. Due to the pressures of dealing with Covid-19, telehealth is pushing our healthcare into the next generation.
When the pandemic surged in the U.S. back in March, a shortage of personal protective equipment (PPE) and tests for the virus amplified the fear that a not well understood contagion would spread through our hospitals like wildfire, infecting both other patients and healthcare workers. In an effort to minimize the spread, virtual visits with primary care physicians, along with Covid-19 call centers, were set up for patients to contact physicians and discuss their symptoms. Only if the symptoms were deemed serious enough would visits to the emergency room be arranged, and then the hospitals meticulously prepared for the arrival of suspected Covid-19 patients. At the same time, to stave off a diversion of resources and to allow for compliance of lockdown regulations, non-Covid-19 patients were directed to communicate virtually with providers.
With telehealth becoming a large part of the plan to tackle Covid-19, on March 27, the President signed the CARES Act, a bipartisan coronavirus relief bill, that lessened the HIPAA regulations to allow Medicare to cover telehealth and thus accelerated the implementation of telehealth as the next generation of healthcare. In August of this year, telehealth Medicare benefits were further proposed by the Trump administration to be expanded permanently.
The dangers of patient to healthcare provider contact are very real. The Covid-19 virus has proven to be highly contagious, according to the World Health Organization (WHO), even more so than the influenza virus. More worrisome, according to Scripps Research Institute, as many as 45% of those infected may report having no symptoms at all. To be clear, lack of symptoms does not seem to equate with lack of health problems as some “asymptomatic” patients have impacted lung function. However, the main risk with asymptomatic carriers is that every person that comes into a physician’s office or a hospital is potentially a Covid-19 carrier, and if healthcare workers are in contact with Covid-19 patients, the physicians and nurses could themselves become infected.
Consequently, healthcare workers need to limit their exposure to patients. For the same reasons, patients fear being exposed to asymptomatic but infected healthcare workers or other patients. An even more troubling issue is that those who frequent healthcare medical centers the most, our seniors and those with comorbidities, have a much higher mortality rate due to Covid-19. These patients know that fact and it appears that many patients are now avoiding healthcare whatever the cost. According to the Centers for Disease Control and Prevention (CDC), between March and May there was a 42% decrease in emergency room visits.
Telehealth has helped to mitigate these risks. Calls to primary physicians or to Covid-19 call centers are used to triage patients. To avoid infecting others, patients with mild symptoms have been isolated at home and those with severe symptoms are isolated in hospitals. Virtual meetings with doctors via electronic devices have provided a method of communication between providers and patients even when isolated. Video conferencing has also allowed physicians to reach out to each other within and between medical centers without putting each other at risk.
Those with health issues will have to see doctors. Unfortunately, though, it appears that Covid-19 is here to stay in the U.S. With sizable numbers of people in the U.S. refusing to follow mask or social distancing guidelines, Covid-19 may never be stomped out until there is a vaccine, but even the idea that a vaccine will stop the virus is not certain. According to the CDC, the influenza vaccination is only between 40 to 60% effective because the influenza virus mutates rapidly among other reasons. Vaccines target a specific virus. When the vaccine is manufactured months later, if the virus has mutated, the vaccine may not be effective. Fortunately for vaccine makers, Covid-19 appears to mutate at a slower rate. Still, the vaccine may only be 70% effective rather than 100%.
This mutation rate could be a moot point. A survey by the Associated Press found that 20% of Americans would not take the vaccine and 31% were not sure if they would. According to Dr. Anthony Fauci, combining a vaccine that is only 70 to 75% effective for obtaining immunity to the Covid-19 virus with the proportion of Americans planning to not get the vaccine could result in the U.S. never reaching herd immunity. Herd immunity is when enough of the population is immune to the virus, either by having been sick and recovered or by having had the vaccine, so the rest of the population is then insulated from contracting the virus.
If the Covid-19 virus is not wiped out in the U.S., there is a high probability that Covid-19 will continue traveling within the community or be reintroduced as people begin to travel. These viral remnants increase the likelihood of a mutated version of Covid-19 resurfacing and restarting the pandemic.
Many Americans have been pushing off surgeries and doctor visits in large part due to their fear of the coronavirus. Additionally, as part of risk management to ensure that hospitals were not overrun, at times hospitals, local governments and state governments suspended nonessential surgeries and treatments. That the crisis does not seem to be coming to a close anytime soon means that social distancing measures and the need for remote medicine may continue far into the future. Rather than going back to traditional doctor visits, telehealth will probably continue to expand. Already, there is bipartisan support for making the telehealth expansion permanent even after the pandemic is over. This crisis is ushering us into a new age.
Technology continues to develop. High-speed internet infrastructure has allowed for video calls to replace normal audio calls. Virtual checkups connect patients to providers and providers to other providers. Even before Covid-19, video conferencing was already being used in ambulances between EMTs and neurologists for stroke victims. With Medicare taking up telehealth as a legitimate form of care, expect virtual checkups to increase.
In this new age, physicians may need to hand over more of the initial diagnostic inspections to the patients. Companies like TytoCare already sell self-healthcare devices that can be connected to smartphones. Hard diagnostic data can be taken on body temperature, heart and lung sounds, throat images, skin images, and abdomen sounds and sent to physicians for further inspection. Smart watches provide electrocardiogram (ECG) readings. Other devices, like Leman Micro Devices (LMDs) V-sensor, allows patients to measure their blood pressure, respiration rate, and blood oxygen level. Once the data is received and analyzed, physicians can make decisions about the next treatment steps without ever having met the patients in person.
Physicians, themselves, may soon be removed from the patient diagnostics. Deep learning systems are advancing quickly in medical diagnostics with startling results. An example was given by a study in 2016 of a deep-learning neural network that was used to diagnose diabetic retinopathy. 128,000 retinal images were evaluated by opthamologists and then were used to train Artificial Intelligence (AI) to recognize retinal abnormalities. After the training, the AI’s algorithm was able to correctly diagnose retinopathy at the same rates as the opthamologists. In another example, DeepGene, an advanced artificial intelligence cancer type classifier, was able to outperform three widely-adopted existing classifiers. Computers are already surpassing physicians in a number of diagnostic areas, and with the rate of development, and some extra money to incentivize the field, AI systems will take over pathology diagnostics.
As healthcare device add-ons for our smartphones continue to improve along with AI algorithms, the need to visit physicians face to face will decrease dramatically. The devices will take the initial data, send it to their provider who will feed the data into an algorithm, which then will provide a treatment plan or request additional tests. Even for testing, a doctor’s visit may not be necessary, as we have seen with the advent of drive-thru Covid-19 testing services. Fluids like urine can be collected at home and dropped off or sent to a testing facility. Even microsamples of blood can be collected at home. For preliminary tests these methods may be sufficient. To eliminate the possibility of improperly collected samples or fraud, blood samples could also be collected at drive-thru testing facilities by appointment.
Of course, physicians will not be eliminated, just pushed to a distance. No matter how many tests can be done at home, the most advanced tests will have to be done at medical centers. No matter how much AI can do, physicians will be required to double check any treatment advised. Computers assist surgeons, but they are not yet at the level to replace surgeons. With these advances, though, the human traffic in direct contact with healthcare providers could decrease significantly.
Telehealth is going to revolutionize medicine. The benefits can outlive the pandemic. Eleven million Americans live in a county that does not have a hospital; 2.7 million of those in counties without hospitals are seniors. For seniors, trips to and from physician offices or hospitals could be trying in normal times but are especially so during a pandemic. And for those without a hospital nearby, quality telehealth could present better options than the existing options. Then there are also remote rural areas and Native American reservations with few viable medical centers close by. Assuming that the availability of WiFi bandwidth can be improved in those areas, telehealth advances could greatly increase the quality of life of those areas.
Benefits could also include reduced time off from work, less time commuting, and more time spent with families. During treatment, nurses and physicians could remotely check on vitals while the patient is at home, rather than require admittance into a hospital, which would free up capacity at the hospital and could potentially save the patient from getting sick with a pathogen present at the hospital.
The pandemic is causing widespread pain and suffering. A silver lining to this dark cloud is that the crisis is providing the spark to revolutionize healthcare. Telehealth is our future.