COVID-19 on the tele-front lines: What telehealth nurses are encountering in the coronavirus battle

A telehealth VP describes the concerns and trends her team is hearing from an influx of worried patients.
By Kathy Lozano
11:58 am

About the author: Kathy Lozano is VP of clinical operations at Carenet Health, a San Antonio, Texas-based telehealth nursing and virtual clinic provider.

Telehealth has emerged as a critical tool in the fight against COVID-19, helping to ease the burden on traditional healthcare providers by encouraging patients with unrelated mild or moderate ailments to get care via phone or online. It has also become a vital lifeline for a steadily growing number of panicked callers who are feeling symptoms of the virus but are afraid to seek in-person treatment or unable to access just-in-time guidance from other healthcare sources, such as overloaded primary care practices.

How are the nation’s telehealth professionals dealing with this challenge, and what are they hearing and seeing when they open a virtual window into patients’ homes during the COVID-19 pandemic? Carenet Health is a telehealth provider that supports more than 65 million healthcare consumers on behalf of 250 of the nation’s largest health plans, providers, health systems and large employers. In a recent 10-day period, we’ve seen a 1,600% increase in the number of COVID-19 triage screenings, and our overall case volume is up anywhere from 60% to 80%, depending on the time of day. Patients are calling for everything from urgent symptom-assessment, to at-home treatment guidance, to testing questions to simple reassurance.

Based on feedback from our frontline registered nurses, who are taking calls 24 hours a day from every state in the U.S., here are some of the most important insights from our patient interactions over the past week.

Patients want to avoid emergency departments

Because of the way COVID-19 spreads – quickly and easily – keeping infected patients experiencing nonurgent symptoms away from crowded emergency departments (EDs) has been an important communication from local, state and federal government and healthcare authorities. Telehealth patients have clearly gotten this message, and many are trying their best to avoid going to the ED. In some cases, though, we’re finding patients are avoiding physical contact with the healthcare system, even when we’ve assessed their situation and have determined they need in-person care.

“It was surprising that, in the instances when we’ve told patients that they need to go to the ER, these callers highly resist, even when they’re having difficulty breathing,” said one Carenet Health nurse. “Patients have been educated so well about not going to the ER during the pandemic that they are now fearful to go, even when it’s warranted.”

This seems to be particularly true among elderly patients, who know they are at a higher risk for serious COVID-19 complications and death.

The lack of preparedness

While some patients have grasped the full severity of the situation, others are still surprisingly underprepared.

“Despite the advisories that have been issued to make sure people have two weeks of supplies at home in case the need for self-quarantine arises, some callers are ill-prepared,” said one of our nurses, echoing a sentiment others shared as well. “In some cases, patients who are showing symptoms do not have thermometers in the home to gauge if they have a fever, or don’t have any acetaminophen to help manage a fever if they are presenting one. Then they’re tempted to try to go get some, but in many cases the shelves are empty.”

Misinformation has also been an issue. “The things people believe as truth from neighbors and friends can be alarming,” said another nurse. “From the calls we get, it’s clear social media is not only putting people on edge, but also confusing people.”

The moving target of providing care

Many of the country’s medical providers are fighting to keep up with the breakneck pace of the growing pandemic, and that means more and more patients are turning to telehealth care as an extension of their primary care physician’s office. We’re proud to be an ally to traditional care facilities as they work to manage patient-clinician loads, keep patients safe and regulate the heightened flow of patients who need help. And that means supporting a new category of patients who are COVID-19-symptomatic and highly contagious to other patients.

We’re also serving patients who cannot get in to see their doctor for non-COVID symptoms right away. As the crisis evolves, it’s going to take telehealth and MD offices depending on each other and working together even more closely to find creative and safe ways to care for patients.

The rising need for mental health support

As social distancing has been implemented and news on the pandemic worsens, we’re seeing an increase in telehealth patients who are experiencing mental health issues, such as acute anxiety and depression. We’re especially seeing that volume intensifying in the younger, college-age population.

The isolation aspect of this pandemic appears to be beginning to take its toll on young adults who aren’t used to having their social life restricted, and who believed up until recently that they shouldn’t be worried about COVID-19. Now they’re experiencing symptoms, they’re concerned, and our nurses are not only assessing them for the virus, but also assisting them with coping skills for mental wellness.

The long road ahead

It’s clear that our fight against COVID-19 is just beginning, but we are seeing some positive signs. For every caller who isn’t prepared to weather this storm, there are many more who are, and are taking the preventive measures to stop the spread seriously.

We may not know what lies ahead, but one thing is certain: Nurses will keep answering the call, whether in person, on the phone or online, and we will persevere through the worst and see things through to the other side.


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