Overflowing waiting rooms. Beds crowded into intensive care units. Medical personnel in head-to-toe protection, scrambling to attend to the growing number of patients coming through the door.
Medical centers around the world are being overwhelmed by people seeking testing and treatment for the coronavirus, and experts warn if American hospitals can’t control the evaluation, intake, and treatment of the country’s most critical patients, they won’t win the fight.
“The ability to sustain our great hospital systems over the long term has to do directly with the ability to control the volume and pace of critically ill patients that require extensive hospital care,” said MIT Sloan professor Retsef Levi during an online congressional staff briefing hosted by the COVID-19 Policy Alliance.
Levi is one of two MIT Sloan professors who convened the alliance in mid-March, along with Simon Johnson, a professor of global economics and management.
Following the White House’s March 13 announcement allowing different agencies to take advantage of telehealth technology to combat the virus, the COVID-19 Policy Alliance released a report with details of specific ways telemedicine can be deployed to deliver immediate value.
Telemedicine allows health care providers to evenly spread out resources, said Roy Schoenberg, alliance member and CEO of telehealth company AmWell.
“We need everybody to take the initiative to both say let's make it so, and we need the initiatives to remove some of the administrative and legislative realities that have been created for a health care system that was built 20 or 30 years ago,” Schoenberg said. “This can be done within a week or ten days in a meaningful way.”
Here are four steps to change the system — along with estimations from the alliance of how long it would take to get such systems up and running:
Implement mass testing without spreading the infection
If someone wants to be tested, the report recommends they must first be triaged through a telemedicine system to determine the appropriateness of the request and to schedule an appointment at a designated site.
This helps to prevent overcrowding at one testing site over another and reduces the number of calls to 9-1-1 or other local government numbers.
The testing request can be:
- Conducted via phone or a video call.
- Handled by a call center staffer rather than a clinician.
- Used to reassure the person, and inform them of testing wait times.
Timeline: Three days for a basic functioning system.
Prevent hospitals from becoming infected
The report recommends that no walk-ins be allowed even as emergency medical services remain uninterrupted. That means emergencies like heart attacks or strokes can get immediate permission for emergency room access from a remote medical care provider, with a rapid COVID-19 test required. To achieve that goal, the report recommends putting 20-minute tests in ambulances.
Access to the emergency room is only permitted with an appointment after the triage call. The goals are to:
- Direct any potentially infected person away from most hospitals and toward dedicated testing sites.
- Avoid confrontations and potentially violent situations at emergency room entrances.
- Allow medical professionals quarantined or offsite to participate in triage.
Timeline: Four days for a basic functioning system.
Treat thousands of mild case infections
People with mild cases of the coronavirus do need medical attention, but they can recover away from hospitals and clinics. Telemedicine can help regularly reassure these patients that they are OK, and encourage self-monitoring.
Timeline: six days for a basic functioning system.
Prevent disastrous cluster of infections exceeding ICU capacity
High-risk people like those in nursing homes and assisted care facilities should receive ongoing medical attention remotely in their homes and be dissuaded from seeking office visits for routine care.
The report recommends getting these individuals set up with their regular doctor for remote treatment as soon as possible. The same telemedicine platform can be used to help with food and pharmacy deliveries.
Timeline: 6 days for basic functioning system.
Ideally, the report states, these remote solutions would be delivered through a state-level telemedicine system developed in concert with health systems, one or more telehealth companies, pharmacies, delivery and logistics organizations, and law enforcement. State government should provide legislative and budgetary support, and operational planning and coordination.