UrbanUpdate

We’re weeks into the coronavirus crisis, and social distancing has somehow become second-nature for most of us. However, this advice was not just issued for the healthy or otherwise asymptomatic—it also applied to those experiencing mild or non-critical symptoms of COVID-19. Emergency rooms are over capacity and there are dire shortages of necessary protective equipment for healthcare workers. Doctors in New York City, the epicenter of America’s coronavirus crisis, are warning that care may need to be rationed; some people may die simply because there are not enough resources to help everyone. It’s not a good idea to go to the doctor or the hospital unless you absolutely have to, which is why telemedicine systems—apps and other systems designed to connect you with medical professionals remotely—have become critical, and why you should know how to use them.

The CDC quickly recommended that hospitals and health clinics consider ramping up (or completely creating) telemedicine services towards the beginning of the pandemic, knowing that a virtual consultation was the least hazardous, most efficient way to provide non-emergency care in the midst of the chaos to come. By staying home, you limit your chances of catching the virus—or, if you have only mild symptoms, of spreading it further. That reduces the burden on emergency rooms, which need to focus on high-risk cases, which include COVID-19 but also the ER’s usuals: car accidents, strokes, and heart attacks.

“It’s been really nice to keep people out of the hospital that don’t need to be there,” says one New York City-based telemedicine doctor who agreed to speak with GQ on the condition of anonymity. (Many hospitals are taking punitive action against personnel who speak with the press.) “It’s rewarding to know that patients are getting the information, treatment, and medications they need from the safety of their own home.”

Emergency Telemedicine

Welcome to the virtual ER. Rather than driving to the hospital, you’ll visit your preferred hospital's website and dig for a telemedicine portal. (Or, given that many hospital websites are unwieldy mazes, Google the hospital name and “telemedicine.”) While the nature of telemedicine makes it theoretically possible to shop around for a hospital, there are regulatory issues with practicing medicine across state lines, and it makes sense to use the hospital you would go to in person to ensure an easier transition of records and such if that becomes necessary.

You’ll be prompted to turn on your computer’s camera, which most doctors would say is ideal—but if video isn’t an option, make sure you take a recent photo of anything the doctor may need to see (an injury, or your throat if you’re experiencing soreness). These ER "visits" are billed to your insurance in the exact same way as IRL—though you may want to double-check this with your insurance provider before using a given service. As with any ER or urgent care visit, you should come prepared with your reason for needing a doctor. Then, you’ll generally be asked the same questions you would be during a routine check-up: allergies, pre-existing medical conditions, how long your symptoms have occurred, and so on.

"Here, I sit down and people tell me their stories, and then we talk about what comes next."

For a non-critical patient, virtual medicine can achieve “at least 90% of a normal ER visit,” the anonymous NYC doctor says. If all the technology is working (access to Wi-Fi and video chat is crucial for the best possible results), a doctor can “make a decision about prescribing medications to help their symptoms, consider antibiotics, and do most of a typical physical exam.” Some patients who frequently use telemedicine even purchase home pulse oximeters (which indicate your oxygen saturation) so they can present their vital signs to their doctor during the call. And this maybe goes without saying, but you should also keep a thermometer handy, especially since COVID-19 may manifest with a fever.

A potential benefit of telemedicine is the democratization of care, and where an in-person ER visit can run hundreds—if not thousands—of dollars, many telemedicine services provide standard rates (typically between $49 and $150) for the uninsured.

Consultations like these are effective during the COVID-19 pandemic, since the virus presents symptoms similar to a cold, the seasonal flu, or even bad allergies—fever, cough, fatigue, body ache, sore throat, and diarrhea. Telemedicine is a great way to break a cycle that's well-known to emergency physicians: patients think they might have the symptoms of coronavirus, but resist consulting a doctor in case it’s not coronavirus...then they watch the news and worry they’re going to die either way. “Patients are seeing the headlines and freaking out,” the doctor says. “However, in most of the cases, I can tell them that they look really well and are probably going to be fine, but to call me again if their symptoms change.”

Repeat “visits” are common with telemedicine in the age of COVID-19, which can be a finicky and deceptive virus. “It often lasts two weeks, and people will feel it, then feel better, then get a little worse. It fluctuates,” the doctor says. Luckily, scheduling a telemedicine appointment is nowhere near as arduous an experience as visiting an emergency room, where you could wait hours before seeing a medical professional. You also get the benefit of uninterrupted one-on-one time with an actual doctor.

“A lot of my time in the emergency room will be spent on management,” the doctor says. “I could talk to somebody for a few minutes, then order their labs, then call the radiologist or talk to a surgeon or get asked a question by another patient. This, on the other hand, is all face-to-face conversation all day long.”

Routine Telemedicine

Urgent care isn’t the only form of telemedicine seeing an uptick right now. Given that a routine visit to the doctor probably isn’t wise or even possible while we’re all on lockdown, general care physicians and specialists like dermatologists have begun offering remote “visits.” Check if your current doctor is offering telemedicine, but if not, find-a-doctor services like Zocdoc will allow you to sort by those that are. Most of the major medical institutions—from Permanente Medical Group to NYU Langone—have virtual options available, while telemedicine companies like Amwell, Ro, and Zoom+Care are native to the industry.

One particularly promising branch of telemedicine is mental healthcare. This could be as simple as switching an existing patient from in-person visits to video conferences, but there have been some higher-tech solutions as well, including Betterhelp, MDLive, or the more specialized services like Regain (couples therapy) or Pride Counseling (for LGBTQ f+ folks). Talkspace is the best known of them all, which is probably why they have reported a 65 percent user-volume increase in the social distance age. Talkspace works off a subscription model, ranging in price from $65 to $100 a week. You basically log on, take a quick assessment, and then can start chatting (text or video) with a professional shortly thereafter.

Dr. Neil Leibowitz, the brand’s chief medical advisor, says that many in this new clientele arrived due to anxiety about the immediate risk of contracting coronavirus. However, he says, that was just the beginning. As the effects of the disease became felt across the economy, there was a second wave of inquiries related to economic and financial fears. Now, the therapists and psychiatrists of Talkspace are fielding an increasing amount of concerns from patients who are growing weary of being stuck at home. “People are spending a lot more time with significant others. For relationships that had problems before, those are now worse,” Dr. Leibowitz says. Such dynamics can also be aggravated by children or in-laws being in the house all of the time.

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Of course, there’s always the flip-side. “Many people have a thousand Facebook friends but are sitting at home feeling very lonely,” Dr. Leibowitz adds. The therapists aren’t just there to help people cope, it seems—they’re also someone new to talk to.

As a whole, the boom in telemedicine is likely to translate to a long-lasting change for both medical providers and their patients—specifically because it eliminates many barriers to care that typically prevented people from participation. “If you’re sitting on your bed [for an appointment] and that’s what’s comfortable for you, you’re probably going to be more open about your life if you have that comfort,” Dr. Leibowitz says. This, he says, is a part of Talkspace’s success: more patients are willing to try therapy if they do so from the comfort of their own homes. If they like it, it also means they’re less likely to skip appointments or cancel, thus falling out of the habit of therapy altogether. This makes a once rarefied space a lot more approachable—especially if it falls under your health plan.

For the New York City-based doctor, telemedicine has provided a refreshing perspective into how they approach the quality of care—an astonishing observation considering the overwhelming number of people in need of assistance. “The guidelines tell us not to interrupt, to just listen,” they say. “In the ER, I often interrupt just because I have follow-up questions or get pulled away for a more urgent task. Here, I sit down and people tell me their stories, and then we talk about what comes next.”

“They’re just 15-minute visits, but people are genuinely grateful and relieved at the end of the call that they received personalized attention,” they say. “They got to ask all of their questions, and they got what they needed.”

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