This may be telemedicine’s moment in the spotlight, but virtual visits have been around since the ’90s. Telemedicine is the most well funded segment of digital health startups, bringing in $1.8 billion in venture capital last year. This includes specialized startups like Roman, where video consultations and online prescriptions are the main service, and larger medical centers and hospitals offering their own telehealth services. As part of the $8.3 billion coronavirus relief bill, the government gave the Department of Health and Human Services the authority to waive some restrictions around Medicare coverage for telehealth.
“We’ve seen about a 30 percent increase compared with December,” said James Wantuck, physician and cofounder of Plushcare, a health care platform offering virtual visits and online screening. “So, the volume is increasing a lot, but it’s a very small percentage of those people today that we’re actually worried are infected with [coronavirus], on the order of about 1 percent.”
Patients in waiting rooms aren’t the only ones at risk. Hospitals across the country report mask shortages. Hospital staff and TSA workers have tested positive after coming into contact with patients.
Limiting hospital admittance to those who are at higher risk of being infected is essential if we are to “flatten the curve” of the virus’s spread. If too many people are referred to treatment, hospitals waste valuable resources and risk workers’ health; not enough, and those with untreated infections spread the virus to countless others.
For now, the CDC prioritizes testing those who meet specific criteria: recent travel to “level 3” affected areas like China, Iran, or South Korea; ongoing severe symptoms like fever, coughing, and shortness of breath; and patients with pre-existing conditions: diabetes, lung disease, or those taking immunosuppressants. Health officials say the lack of readily available testing means the reported number of infected in the US, more than 1,700, is deceptively low.
“No one has high blood pressure if you don’t have blood pressure cuffs,” said Dr. Caesar Djavaherian, a San Francisco physician and co-founder of Carbon Health, another healthcare platform which also saw a recent spike in telehealth requests. “As soon as you have [them], you notice that a lot of people have high blood pressure. That’s what happened this week. Next week, it’ll happen to a much larger extent.”
Generally, telehealth and “virtual visit” apps begin with an intake form: What are the patient’s symptoms? How long have they had them? Where have they traveled recently? Depending on the severity of symptoms and whether they live in an outbreak area, users may be referred to a doctor, who will counsel them on visiting a hospital, staying in and monitoring their symptoms, or other steps. Virtual visits are faster than in-person visits, but, importantly, they don’t diagnose anything. None of the virtual visit or telehealth apps can conclusively tell a patient whether they’re infected with coronavirus.
“We give them advice for follow up,” said Dr. Peter Antall, cofounder of American Well, another healthtech platform that’s seen an increase in telehealth requests, “either definitive follow up, like ‘I need you to be seen within the next 72 hours by your primary care doctor’ or, conditional follow up, where we say, ‘Hey, this looks fine. Now, if you begin to develop anything like breathing difficulty, deep cough, high fever. I do need you to be seen.’”
Ryan, who asked not to identify his last name, turned to Reddit last weekend looking for an answer. He had fever, a bad cough, and difficulty breathing. Without a regular doctor, Ryan started calling centers in New York. Health officials made it clear to him they were only recommending the most dire cases for evaluation. Even fewer were likely to get tested for the virus.