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| The New Language of Telehealth | The New Language of Telehealth |
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| As I wait for the interpreter to call the mother and then connect me into our three-way call, I berate myself for how bad my Spanish has become. I imagine it will continue to get worse. But what I am also realizing in this 30 seconds of dead airtime is that my overall communication skills are dwindling, too. I realize that in normal, non-Covid times, I do a lot of nonverbal communication with my patients. That I can’t do over the telephone. | As I wait for the interpreter to call the mother and then connect me into our three-way call, I berate myself for how bad my Spanish has become. I imagine it will continue to get worse. But what I am also realizing in this 30 seconds of dead airtime is that my overall communication skills are dwindling, too. I realize that in normal, non-Covid times, I do a lot of nonverbal communication with my patients. That I can’t do over the telephone. |
| Calling my patients at home, with or without video, has become my new normal. After 25 years of being a pediatrician, telemedicine is teaching me new ways to communicate with families. On the phone, with or without an interpreter, I try to listen carefully to the pauses in a mother’s voice, to know when it is my turn to speak and ask questions. It’s hard to tell if a patient is done speaking or just pausing. I find myself interrupting patients far more than I do with face-to-face visits. | Calling my patients at home, with or without video, has become my new normal. After 25 years of being a pediatrician, telemedicine is teaching me new ways to communicate with families. On the phone, with or without an interpreter, I try to listen carefully to the pauses in a mother’s voice, to know when it is my turn to speak and ask questions. It’s hard to tell if a patient is done speaking or just pausing. I find myself interrupting patients far more than I do with face-to-face visits. |
| I try to hear the mother above the babbling of her baby. And then to listen to the babbling of the baby. Is it joyful? Are there big breaths between the babbling? | I try to hear the mother above the babbling of her baby. And then to listen to the babbling of the baby. Is it joyful? Are there big breaths between the babbling? |
| A federal government waiver, issued early in March, expanded the use of federally funded health insurance — Medicaid, Medicare and the Children’s Health Insurance Program — to pay for telemedicine visits. The goal was to allow more people with symptoms of illness to be heard, and sometimes also seen, by a health care provider without the risk of exposure to coronavirus at a doctor’s office or hospital. The federal government has been expanding the use of telemedicine for years — but like so many changes in this pandemic, what used to take years to transform, we are now doing within weeks. | A federal government waiver, issued early in March, expanded the use of federally funded health insurance — Medicaid, Medicare and the Children’s Health Insurance Program — to pay for telemedicine visits. The goal was to allow more people with symptoms of illness to be heard, and sometimes also seen, by a health care provider without the risk of exposure to coronavirus at a doctor’s office or hospital. The federal government has been expanding the use of telemedicine for years — but like so many changes in this pandemic, what used to take years to transform, we are now doing within weeks. |
| In my former life of face-to-face visits, when I walked into an exam room, introduced myself, and sat down — long before I laid hands or a stethoscope on the baby — I watched the baby breathe. Is her chest heaving with every breath? Is she flaring her nostrils? Is her mouth moist? The equivalent over the phone may be trying to appreciate how worried the mother’s voice sounds. But it’s no substitute. | In my former life of face-to-face visits, when I walked into an exam room, introduced myself, and sat down — long before I laid hands or a stethoscope on the baby — I watched the baby breathe. Is her chest heaving with every breath? Is she flaring her nostrils? Is her mouth moist? The equivalent over the phone may be trying to appreciate how worried the mother’s voice sounds. But it’s no substitute. |
| In face-to-face visits, when I’ve decided that the symptoms the mother is worried about are a common cold and not something serious, I try to show the mother how, despite the runny nose and cough, her infant is doing well. I often hold a not-yet-walking infant under her arms while the mother and I watch in awe as the infant holds her head up and takes a step forward. “Que fuerza ella tiene!” | In face-to-face visits, when I’ve decided that the symptoms the mother is worried about are a common cold and not something serious, I try to show the mother how, despite the runny nose and cough, her infant is doing well. I often hold a not-yet-walking infant under her arms while the mother and I watch in awe as the infant holds her head up and takes a step forward. “Que fuerza ella tiene!” |
| On the phone, as I listen to the interpreter tell me that the mother said that the child does not have a fever and is eating and sleeping well, I am convinced that the symptoms are from the common cold. But I have no similar magic trick to boost the mother’s confidence in my diagnosis. | On the phone, as I listen to the interpreter tell me that the mother said that the child does not have a fever and is eating and sleeping well, I am convinced that the symptoms are from the common cold. But I have no similar magic trick to boost the mother’s confidence in my diagnosis. |
| Seeing the same families over and over, watching their children grow, the parents and I build trust. In face-to-face visits, I try to build trust in all the ways we teach our students: I introduce myself, I sit down, I listen, I hold their hands when it feels appropriate. And when a pediatric visit calls for it, I follow a toddler under the desk, squatting to get my stethoscope on his chest. | Seeing the same families over and over, watching their children grow, the parents and I build trust. In face-to-face visits, I try to build trust in all the ways we teach our students: I introduce myself, I sit down, I listen, I hold their hands when it feels appropriate. And when a pediatric visit calls for it, I follow a toddler under the desk, squatting to get my stethoscope on his chest. |
| Sometimes on the phone or video, there’s a delay or echo. It might be caused by the bad internet I have at home. But it might be the patient’s bad internet, who knows. | Sometimes on the phone or video, there’s a delay or echo. It might be caused by the bad internet I have at home. But it might be the patient’s bad internet, who knows. |
| I know in many ways I am lucky. Many of my colleagues are taking care of patients who are sick or dying from Covid-19, at high risk to themselves. I have a paying job that allows me to work from home. I had asked to stop seeing patients face-to-face early in the pandemic, because I am being treated for metastatic colon cancer and am immunocompromised. | I know in many ways I am lucky. Many of my colleagues are taking care of patients who are sick or dying from Covid-19, at high risk to themselves. I have a paying job that allows me to work from home. I had asked to stop seeing patients face-to-face early in the pandemic, because I am being treated for metastatic colon cancer and am immunocompromised. |
| Despite the nausea and vomiting my biweekly chemo appointments bring, they remind me of the pleasures of face-to-face health care. I am wearing a mask, my providers are wearing masks, and yet face-to-face, I can see in their eyes when they are smiling. We can watch each other’s body language to see when it’s the other person’s turn to start speaking. Masks are not great for communication, but they easily surpass telehealth. | Despite the nausea and vomiting my biweekly chemo appointments bring, they remind me of the pleasures of face-to-face health care. I am wearing a mask, my providers are wearing masks, and yet face-to-face, I can see in their eyes when they are smiling. We can watch each other’s body language to see when it’s the other person’s turn to start speaking. Masks are not great for communication, but they easily surpass telehealth. |
| Updated June 16, 2020 | Updated June 16, 2020 |
| 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. |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
| 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.) |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| 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. |
| I am getting better at it, though. I started by using my landline, which had better reception than my cellphone, then returned to my cellphone after downloading some apps that allowed my patients and me to hear each other more clearly. Now I have a hospital-issued cellphone with greater security and apps that make a video call easier. | I am getting better at it, though. I started by using my landline, which had better reception than my cellphone, then returned to my cellphone after downloading some apps that allowed my patients and me to hear each other more clearly. Now I have a hospital-issued cellphone with greater security and apps that make a video call easier. |
| Some of the changes we make and the new skills we develop during this pandemic will be worth sustaining long after it is over. I am learning to listen for when it is my turn to speak, to diagnose rashes on a phone screen, to identify emotions from words and tone as much as from facial expressions. I am working on building trust over the phone. | Some of the changes we make and the new skills we develop during this pandemic will be worth sustaining long after it is over. I am learning to listen for when it is my turn to speak, to diagnose rashes on a phone screen, to identify emotions from words and tone as much as from facial expressions. I am working on building trust over the phone. |
| At the end of a face-to-face visit, I always ask the parent, usually a mother, if there’s anything else I can do for her today. She may have some questions while we are both sitting down, her baby on her lap. Or she may not have any questions until my hand is on the door handle to leave and she says, “Oh, doctor, one more thing…,” which often turns out to be the most important part of the visit. | At the end of a face-to-face visit, I always ask the parent, usually a mother, if there’s anything else I can do for her today. She may have some questions while we are both sitting down, her baby on her lap. Or she may not have any questions until my hand is on the door handle to leave and she says, “Oh, doctor, one more thing…,” which often turns out to be the most important part of the visit. |
| Now, at the end of this virtual visit, I ask the mother if there’s anything else I can do for her today. She says no, she’s set, she just wanted to know if she should bring her baby to the emergency room, and she’s relieved she doesn’t have to. I say great, that she should feel free to call us back if she has any other questions. She says goodbye, the translator says goodbye, and then I say goodbye. And then there is a little bit of dead airtime before we all find the right button to hang up. | Now, at the end of this virtual visit, I ask the mother if there’s anything else I can do for her today. She says no, she’s set, she just wanted to know if she should bring her baby to the emergency room, and she’s relieved she doesn’t have to. I say great, that she should feel free to call us back if she has any other questions. She says goodbye, the translator says goodbye, and then I say goodbye. And then there is a little bit of dead airtime before we all find the right button to hang up. |
| Marjorie Rosenthal is a pediatrician at Yale. | Marjorie Rosenthal is a pediatrician at Yale. |