Science | 03.09.2020 07:00 AM
Worried About Covid-19? Hospitals Have a Request: Stay Home
As Covid-19 spreads across 13 states and public health officials urge Americans to work from home, wash their hands, and stop touching their faces, hospitals and urgent care clinics are preparing for an onslaught of feverish, coughing, and highly contagious patients.
Hospitals are stocking up on protective gear for staff, preparing quarantine rooms, and coordinating with state health departments, which are in charge of testing to confirm suspected novel coronavirus cases. But the number one strategy hospitals and urgent care clinics are relying on isn’t face masks or isolation wards: It’s asking people to stay home.
Plus: How can I avoid catching it? Is Covid-19 more deadly than the flu? Our in-house Know-It-Alls answer your questions.
“We’re ready,” says Jeff Rabrich, director of emergency medicine at Montefiore Nyack Hospital in New York. Rabrich isn’t worried about handling a surge of very sick patients. But he is concerned about the “worried well”—people who aren’t sick, or who only have mild symptoms, but who come into the hospital anyway and take up valuable resources. “We don’t want people who are relatively well coming to the hospital,” he says.
Right now Rabrich says that every day the emergency department is fielding a couple dozen calls and five or 10 visits from panicked people wondering if they should get tested for Covid-19. Some have no symptoms at all. In one case, a caller who had eaten Chinese food for dinner and woke up with a low-grade fever worried they caught coronavirus from the food and wanted a test. (To be clear: You cannot get coronavirus from food.)
If someone hasn’t recently traveled to one of the major Covid-19 hot spots like China, South Korea, Italy, Iran, or Japan, and if they haven’t been around a person who has already been diagnosed with the virus, they shouldn’t rush to the hospital the instant they sense a cough or slight fever coming on. “People should not panic about this,” says Rabrich. “The basics still apply just like with the flu: Don’t cough on people, wash your hands, and if you’re mildly ill, do not go to a hospital.”
It’s also a good idea to be realistic about what a hospital or emergency clinic can provide. For patients with shortness of breath, health workers can provide oxygen to help them breathe. They can also evaluate and test people who are experiencing severe symptoms like chest pains or a high fever. But hospital staff still can’t analyze tests on site; they have to wait, sometimes as long as 24 hours, to get results from state testing facilities. There’s no vaccine for this novel coronavirus, and no medicine specifically designed to treat it. For people with milder symptoms, there isn’t much a hospital can do to help. Just as with mild influenza, patients don’t need special care, just lots of rest and fluids. “If you don’t need oxygen,” Rabrich says, “don’t come to the hospital.”
To keep the “worried well” and milder cases out of hospitals, many health systems are advising patients to use remote care or telemedicineportals, which connect patients to doctors via email, text messaging, or video visits. Instead of forcing sick people to get off their couches, telehealth lets people stay in their homes while getting sound medical advice from professionals. Some large hospital chains run their own telehealth services; others are provided by separate telemedicine companies like Teladoc, MDLive, or Doctor on Demand.
After all, most people probably don’t need a Covid-19 test, but they do need to stay away from other people. During a press conference Wednesday meant to educate the public about how Baptist Health Care in Miami is preparing for a coronavirus outbreak, David Mishkin, medical director of Baptist Health Care On Demand, urged people worried about coronavirus to try the hospital’s telehealth service. “We want our patients
to use [Baptist Health Virtual Care] because we know it’s safe, it reduces exposure,” said Mishkin. A virtual visit will help relieve the anxiety people may have about contracting the coronavirus, he said, while also helping them get the care they need. Mishkin added that telehealth could also help patients with other health issues who are afraid to come into the hospital.
Albert Chan, Sutter Health's Chief of Digital Patient Experience, which runs 24 hospitals across Northern California, says that he “cannot imagine scaling a response to an epidemic like Covid-19” without technology. Sutter Health uses video visits as well as an app called Ada, whose AI chatbot asks users a string of questions in order to direct them to the right resources. Chan says these tools have helped Sutter Health officials scale up their response to coronavirus worries and reach patients more quickly and safely than it ever could before.
“Telehealth is widely recognized as a tool in this public health emergency,” says Lori Uscher-Pines, a researcher at the Rand Corporation who studies health care. But, she says, while telehealth could do a lot to ease the burden on hospitals, regulations and reimbursement models have stunted telehealth’s growth. Medicare has traditionally only reimbursed telehealth visits for patients in rural areas. And ironically, these patients can’t always access the service at home. Sometimes they have to go into the clinic in order to have a virtual conference with a doctor located in another city. In those situations, there’s still a danger of spreading a disease to the outside world, because the patient has to leave home and share space with other people.
Additionally, since doctors have to be licensed in the state where their patients are, it makes it harder for independent telehealth companies who want to expand across state lines. Uscher-Pines says these funding and licensing barriers mean that current systems aren’t able to handle a widespread outbreak. “Most health systems and telehealth companies don’t have the capacity to suddenly serve hundreds of thousands patients via telehealth,” she says.
On Thursday, the Senate approved a new funding package to help the Centers for Disease Control, the National Institutes of Health, and Medicare handle the novel coronavirus. In addition to pumping millions of dollars into vaccine research and public education outreach, the package would also allow the Department of Health and Human Services to ease some Medicare restrictions on reimbursements for telemedicine visits.
Another reason doctors hope that people with mild or no symptoms will stay home is that some medical supplies are already limited, and the threat of a global face mask shortage is looming. Doctors can’t distinguish between influenza and the novel coronavirus without a test, but with none commercially available, and with test kits running low at the CDC and state health agencies, many hospitals are trying to conserve the tests they do have.
“Right now, we have what we need to care for our patients,” says Megan Farnsworth, medical director of Providence Medical Group, which runs over 50 hospitals in states including Texas, California, Oregon, and Washington, where Covid-19 cases have been confirmed. Farnsworth says Providence is also developing guidelines that will help conserve masks and other protective gear should supplies start to run low.
At Montefiore hospital, where doctors have tested a few potential Covid-19 patients but haven’t turned up any positive results yet, Rabrich says there are restrictions on when staff can use protective gear like gloves, gowns, and masks, “conserving them for appropriate use so we’re not having wastage or excess use.”
Urgent care clinics that aren’t attached to hospitals are also getting ready to handle novel coronavirus cases, but they don’t have the same resources as hospitals. “Currently, we have signage on our clinics’ front doors stating that if someone believes they have been exposed to Covid-19, or has had exposure to a person who has traveled from China, Italy, Iran, Japan, or South Korea in the past two weeks, to remain outside and call the clinic so a team member can bring them a mask before they enter,” writes a representative for FastMed, one of the country’s largest urgent care chains. While clinics like Fastmed can help identify patients who might need testing and alert local public health departments, they aren’t licensed to run tests and they don’t have the facilities to quarantine patients.
Hospitals, on the other hand, are more ready to hustle patients into quarantine units. Quarantine facilities use negative airflow rooms to control the spread of disease. Infectious patients will be put into rooms that have a lower air pressure than the hallways outside. That pressure differential means that air will flow into the room with the lower pressure, but won’t flow out into the corridor. That keeps airborne pathogens inside the room and leaves common areas clean.
“Health systems constantly drill to prepare for these kinds of situations,” writes Nikhil Bhayani, an infectious disease specialist at Texas Health Resources, which operates 27 hospitals around north Texas, via email.
Hospitals including Sutter Health and Commonspirit, which operates hospitals in 21 states, are also preparing to handle a surge of patients beyond their quarantine capacities by creating barriers within a facility or standing up surge tents where staff can triage patients outside of hospital facilities.
Still, doctors hope those measures won’t be necessary. They point out that most people are going to be just fine. “The vast majority of people are not going to get critically ill or be at risk of dying from this virus,” says Rabrich. If the worst thing that happens to you is feeling nervous … well, you might as well do that at home.
Updated 3-9-20 at 12:04 pm EST: This story was updated to correct the name of Doctor on Demand and Albert Chan's job title.