'Telemedicine Arrives in the U.K.: ‘10 Years of Change in One Week’' diff viewer (11/12)

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Telemedicine Arrives in the U.K.: ‘10 Years of Change in One Week’	Telemedicine Arrives in the U.K.: ‘10 Years of Change in One Week’
2020-06-23 08:12:28 UTC	2020-06-24 00:34:21 UTC (about 16 hours later)
LONDON — A housebound 92-year-old man had red, throbbing legs. A younger patient was complaining of a lump in his armpit. And the self-isolating residents of a nursing home needed checkups.	LONDON — A housebound 92-year-old man had red, throbbing legs. A younger patient was complaining of a lump in his armpit. And the self-isolating residents of a nursing home needed checkups.
Those maladies and needs, once a waiting room’s worth of problems, are now being handled online and over the phone as the coronavirus fans out in Britain and across the world, rendering medical offices no-go zones for all but the sickest patients.	Those maladies and needs, once a waiting room’s worth of problems, are now being handled online and over the phone as the coronavirus fans out in Britain and across the world, rendering medical offices no-go zones for all but the sickest patients.
In a matter of days, a revolution in telemedicine has arrived at the doorsteps of primary care doctors in Europe and the United States. The virtual visits, at first a matter of safety, are now a centerpiece of family doctors’ plans to treat the everyday illnesses and undetected problems that they warn could end up costing additional lives if people do not receive prompt care.	In a matter of days, a revolution in telemedicine has arrived at the doorsteps of primary care doctors in Europe and the United States. The virtual visits, at first a matter of safety, are now a centerpiece of family doctors’ plans to treat the everyday illnesses and undetected problems that they warn could end up costing additional lives if people do not receive prompt care.
“We’re basically witnessing 10 years of change in one week,” said Dr. Sam Wessely, a general practitioner in London. “It used to be that 95 percent of patient contact was face-to-face: You go to see your doctor, as it has been for decades, centuries. But that has changed completely.”	“We’re basically witnessing 10 years of change in one week,” said Dr. Sam Wessely, a general practitioner in London. “It used to be that 95 percent of patient contact was face-to-face: You go to see your doctor, as it has been for decades, centuries. But that has changed completely.”
In Europe, virtual medicine has been held back by strict privacy regulations and patients reluctant to give up in-person doctor’s visits. British primary care doctors, too, have been barraged by growing workloads of late, with patients living longer and more problems being rerouted from hospitals, leaving them little time to train on virtual tools.	In Europe, virtual medicine has been held back by strict privacy regulations and patients reluctant to give up in-person doctor’s visits. British primary care doctors, too, have been barraged by growing workloads of late, with patients living longer and more problems being rerouted from hospitals, leaving them little time to train on virtual tools.
But technology companies are racing to capitalize on a regulatory pullback by governments as they battle the virus.	But technology companies are racing to capitalize on a regulatory pullback by governments as they battle the virus.
Neighborhood doctors, many of them once skeptics, are rushing into the new age, too, singing the praises of virtual visits that they say save them time and offer a useful complement to physical exams.	Neighborhood doctors, many of them once skeptics, are rushing into the new age, too, singing the praises of virtual visits that they say save them time and offer a useful complement to physical exams.
In the past, telemedicine had often involved companies beaming in doctors from hundreds of miles away for a quick prescription or piece of advice. But doctors are now using the same tools to prove to their usual patients that the same level of convenience is available at their local clinics.	In the past, telemedicine had often involved companies beaming in doctors from hundreds of miles away for a quick prescription or piece of advice. But doctors are now using the same tools to prove to their usual patients that the same level of convenience is available at their local clinics.
“I think a lot of it will remain this way after this crisis,” said Beccy Baird, a senior fellow at the King’s Fund, a health care research charity. “What’s really key is that we don’t lose patients’ ongoing relationships with a group of professionals at their home practice.”	“I think a lot of it will remain this way after this crisis,” said Beccy Baird, a senior fellow at the King’s Fund, a health care research charity. “What’s really key is that we don’t lose patients’ ongoing relationships with a group of professionals at their home practice.”
Desperate as health systems are to keep coronavirus patients out of general practitioners’ offices, British doctors say the dams have broken. The telephone system for triaging virus patients is overwhelmed, leaving people pleading with their family doctors for help. Doctors are reluctant to treat infants with serious coughs over the phone. And some patients have other complaints on top of symptoms of the virus.	Desperate as health systems are to keep coronavirus patients out of general practitioners’ offices, British doctors say the dams have broken. The telephone system for triaging virus patients is overwhelmed, leaving people pleading with their family doctors for help. Doctors are reluctant to treat infants with serious coughs over the phone. And some patients have other complaints on top of symptoms of the virus.
In some large primary care practices in London, doctors are setting up so-called dirty zones where they examine patients with respiratory symptoms and clean zones for everything else. Other primary care networks have set up entire clinics, known as “hot hubs,” devoted to possible coronavirus patients who have other pressing health problems.	In some large primary care practices in London, doctors are setting up so-called dirty zones where they examine patients with respiratory symptoms and clean zones for everything else. Other primary care networks have set up entire clinics, known as “hot hubs,” devoted to possible coronavirus patients who have other pressing health problems.
Even so, general practitioners have been making do with almost no protective gear. Doctors have recently peeled back the labels on some shipments of surgical masks only to find years-old expiration dates.	Even so, general practitioners have been making do with almost no protective gear. Doctors have recently peeled back the labels on some shipments of surgical masks only to find years-old expiration dates.
With fears running high that some general practitioners could already be infected, they are all the more eager to treat anyone who can afford to stay home with a video session or a phone call.	With fears running high that some general practitioners could already be infected, they are all the more eager to treat anyone who can afford to stay home with a video session or a phone call.
And as lockdowns in Britain and across the rest of Europe continue and older people are advised to stay home, doctors see virtual visits as the only way of caring for people who can ill afford to lose track of everyday ailments.	And as lockdowns in Britain and across the rest of Europe continue and older people are advised to stay home, doctors see virtual visits as the only way of caring for people who can ill afford to lose track of everyday ailments.
“The risk I pose to residents of a nursing home by going in there is pretty significant, yet they are some of our most frail patients,” said Dr. Paul Deffley, a general practitioner in Brighton, a coastal city in Southern England. “Being able to eyeball someone, to engage in a consultation with them and assess for clinical signs, is an absolute game changer for how we’re able to safely manage people.”	“The risk I pose to residents of a nursing home by going in there is pretty significant, yet they are some of our most frail patients,” said Dr. Paul Deffley, a general practitioner in Brighton, a coastal city in Southern England. “Being able to eyeball someone, to engage in a consultation with them and assess for clinical signs, is an absolute game changer for how we’re able to safely manage people.”
Before the virus, video appointments made up only 1 percent of the 340 million or so annual visits to primary care doctors and nurses in Britain’s National Health Service.	Before the virus, video appointments made up only 1 percent of the 340 million or so annual visits to primary care doctors and nurses in Britain’s National Health Service.
But the health service told thousands of clinics across the country to start switching to remote consultations last month and said it had fast-tracked approval of digital providers to ramp up their offerings.	But the health service told thousands of clinics across the country to start switching to remote consultations last month and said it had fast-tracked approval of digital providers to ramp up their offerings.
Push Doctor, a telemedicine company, said its weekly orders had grown 70 percent since the outbreak. Docly, another company, said demand had increased by 100 percent from one week to the next as the virus spread.	Push Doctor, a telemedicine company, said its weekly orders had grown 70 percent since the outbreak. Docly, another company, said demand had increased by 100 percent from one week to the next as the virus spread.
In the United States, too, Medicare said it would expand coverage for telemedicine across the country, giving millions of older people the chance to get help without leaving their homes.	In the United States, too, Medicare said it would expand coverage for telemedicine across the country, giving millions of older people the chance to get help without leaving their homes.
The shift is striking in Britain, where regulatory hurdles and a cluttered bureaucracy have left telemedicine companies complaining for years about access.	The shift is striking in Britain, where regulatory hurdles and a cluttered bureaucracy have left telemedicine companies complaining for years about access.
Even Germany, where strict standards of privacy and data protection have kept virtual consultations out of the mainstream, has started loosening its rules in response to the virus. The changes could have huge economic implications: The European Commission said in 2018 that the telemedicine market could surpass $40 billion globally by 2021.	Even Germany, where strict standards of privacy and data protection have kept virtual consultations out of the mainstream, has started loosening its rules in response to the virus. The changes could have huge economic implications: The European Commission said in 2018 that the telemedicine market could surpass $40 billion globally by 2021.
“At the moment, the digital providers are rushing to meet demand,” said Graham Kendall, the director of the Digital Healthcare Council, which represents British telemedicine firms.	“At the moment, the digital providers are rushing to meet demand,” said Graham Kendall, the director of the Digital Healthcare Council, which represents British telemedicine firms.
Not all doctors are so sanguine about the shift. Primary care doctors in Britain said they were prescribing more antibiotics, abandoning their usual caution about overuse to avoid in-person appointments.
Updated June 22, 2020	Updated June 22, 2020
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.	A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.	The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.	The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.	So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.	Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.	A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.	The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.	States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.	Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)	If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.	If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.	If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
	Not all doctors are so sanguine about the shift. Primary care doctors in Britain said they were prescribing more antibiotics, abandoning their usual caution about overuse to avoid in-person appointments.
They also worry that they would still be missing cancer diagnoses, for example, that come out of routine, in-office visits.	They also worry that they would still be missing cancer diagnoses, for example, that come out of routine, in-office visits.