I left the U.S. just in time. During my vacation in Australia, I was relieved I would dodge some of the angst and uncertainty in the midst of the COVID-19 epidemic. As it turns out, even this getaway on the opposite side of the world was no escape. Within the span of a day, the markets dropped 10 percent, the remainder of the NBA season was canceled, and the world found out through Twitter that Tom Hanks had been diagnosed with COVID-19 in Australia. I am a telemedicine physician on the frontlines fielding questions about coronavirus. Virtual Care is hands-down the best way to access care for an illness requiring “social distancing” as part of the treatment plan. During this crisis, travel of any kind can be dangerous, and even visiting a doctor’s office can be risky. There has never been a greater need for telemedicine than now. My day of medical consults is typically filled with a variety of situations: A woman who just switched insurances and needs a refill of her blood pressure medication while waiting to see her new PCP. A man who found out that his partner was diagnosed with an STD, inquiring about the next steps. A patient with a painful rash who attached a photo of shingles, and can proceed straight to the pharmacy to pick up her medication. Today, however, the variety was lost. All 25 patients had cough, fever, travel risk, or exposure to someone confirmed for COVID-19. The last patient listed “eye pain” as his complaint. I was excited to break the streak. However, the patient had clicked on the wrong symptom and, in fact, wanted to discuss his cough! Patients requesting a phone call or a video consult to discuss their symptoms typically find their issue resolved over 70 percent of the time. It became evident that with COVID-19 at the forefront of the collective consciousness, patient issues were not going to feel “resolved” at anywhere near that rate. Sure, for the individual who was otherwise healthy and experiencing symptoms of cough and fever, counseling that “This is probably a viral illness, so you need to rest, drink fluids, and let the immune system kick-in to fight it off,” would provide some solace. However, the epidemiologic implications made these visits so much more complicated. A series of questions would logically follow: Do I stay home from work? I work in health care with patients who have chronic kidney disease – How many days or weeks should I stay home? I’m the principal of a school. What are the next steps I should take to keep the teachers and students safe? Do I need to be tested for COVID-19 so I can inform those who were around me when I started to feel ill? I’m 30 weeks pregnant. Should I be worried about my baby? The responses based on CDC guidelines remained unsatisfying. Counseling was couched with the disclaimer: “Based on current CDC recommendations.” Guidelines evolve weekly or daily as we learn more about the illness. Even if one is suspected of having COVID-19, since there is no treatment available and testing kits are in limited supply, individuals who are physically well enough to stay out of the hospital are advised to self-isolate and practice “social distancing.” This means avoiding areas that put others within a 6-feet radius of the individual’s cough. This lowers the risk of transmitting an illness that spreads through respiratory droplets. The lingering uncertainty is difficult. Even with the reassurance that a patient will heal with time, there’s the unknown of whether the individual, in fact, has COVID-19. I had to advise most of my patients that since they are young and do not have other illnesses that put them at risk such as chronic heart, lung, or kidney disease, they would need to become comfortable with the possibility that they might have COVID-19. Epidemiologic and infectious disease experts have echoed the need to be prepared with contingency plans for widespread illness. Ultimately, we will need to learn to be OK with that unsettling feeling of diagnostic uncertainty in the context of limited and imperfect testing resources. I feel reassured knowing that we possess the resources to access medical care on a phone app from the comfort of home and that we are leveraging technology during these trying times of self-isolation to remain connected. Patricia Pechter is a family medicine physician and medical director of virtual care, Oscar Health. Source
