This webinar originally aired on April 21, 2020

Webinar Objectives

  1. Identify state and local government status during this phase of the COVID-19 crisis
  2. Describe the COVID-19 situation in the epicenter and its relevance to the whole country
  3. Understand what to do if asthma worsens during the COVID-19 crisis

Speakers

Dr. Jackie Eghrari, Dr. Purvi Parikh, and Tonya Winders

Summary

Optimal care requires digital tools during the COVID-19 crisis. This webinar looked at the current state of COVID-19 and discussed the situation in New York City, which has been the epicenter of the outbreak. Questions we’ve answered include: What can we learn from this? What about telehealth and safe access to treatment? And what about this albuterol shortage? Dr. Jackie Eghrari, Dr. Purvi Parikh and Tonya Winders speak to this and answered listener questions.

Resources

View the slides

Questions and Answers from the Webinar

The flu is a very common contagious disease and yet extreme social distancing is not recommended to prevent the spread of the flu. Why do we need this level of social distancing?

Flu and COVID-19 are not comparable. The long-term complications and mortality rates of COVID-19 are still unknown. Until more is understood, more aggressive measures must be taken.

COVID-19 is highly contagious and easily spread – sometimes from people who may never show any signs or symptoms at all. The flu affects millions yearly, so getting a flu vaccine is recommended. A vaccine is not yet available for COVID-19, so for those reasons, social distancing is the best line of defense.

How much of the body should be covered with personal protective equipment (PPE)?

The protocols regarding PPE vary depending on the practice setting. Given what is known about the virus and how long it lives in various settings, most of the body should be covered. That includes gowns, gloves, head covering and masks (ideally N95). If a person is going to be closely exposed to body fluids through high-risk procedures, this may require goggles, a mask, or even a respirator.

There is a PPE shortage throughout the country, which actually began back with H1N1. The lack of PPE is a big problem as it endangers the safety of healthcare workers. The general public should not be wearing N95 masks.  Homemade or surgical masks are more appropriate for the general public.

Here is a YouTube video on how to make a mask in 10 minutes.

How long do the COVID-19 antibodies last in a person’s system?

This is not known at this time. However, when looking at other viruses, such as varicella (“Chicken Pox”), the antibody remains in the body for a long time. Antibody tests with COVID-19 haven’t been consistent yet, but it does seem that the virus doesn’t mutate much, so the thought is that once a person has the antibody, it may be present for a long time. Hopefully there will not be new strains of the disease. By the time antibody tests are available, they should be able to identify those that had recent infections.

If someone has been previously intubated, does this increase the risk of complications from COVID-19?

It depends on the reason the person was intubated. For example, if a person was intubated as part of a surgery, that would not increase the risk from COVID-19. However, if the intubation was a result of a chronic lung disease such as asthma, then the risk would be greater.

What is the impact of air quality, weather and temperature on the mortality of COVID-19?

Based upon what has happened so far, air quality has improved in places like China and India as people started staying home. Their hospitalizations from COVID-19 fell, however, this is more likely due to fewer people transmitting the disease rather than an improvement in air quality.

With regards to weather and temperature, COVID-19 does not appear to go away as the weather warms. As summer approaches in the United States and much warmer weather is on the way, it is not yet known how this may impact the spread of the virus.

As for asthma, stormy weather does increase asthma symptoms and ER visits.

Is viral or bacterial pneumonia due to COVID-19 more spread out in the lungs, and does it settle at lower lobes or have a different form?

This can vary depending on the source of the infection. For example, with COVID-19, a scattered infection is seen throughout both lungs. Viral infections present in many different ways and often in cases like the flu, a secondary bacterial pneumonia sets in. By comparison, bacterial pneumonias like to consolidate and often only show up in one area of the lung.

Telehealth and COVID-19

 

Do you believe healthcare practices will forever be changed as a result of COVID-19?

Yes, we expect this will push the healthcare community more towards telehealth, which may lead to better controlled chronic diseases. Through telehealth, patients will have closer contact with their physicians and do so more efficiently and on their schedule. Patients will also be able to access experts in the field that were previously not within their immediate community.

Currently, 20 states have waived the need for the physician to be licensed in the state where a patient resides.

This may also expand options for at-home medications and therapies and mail-order pharmacy options that make it easier for patients to access care and medications directly from home. More therapies such as physical therapy, occupational therapy and speech therapy can also be accessed from home, with oversight from physicians.

Can a pediatric nurse practitioner perform screenings for COVID-19 via telehealth?

For COVID-19 cases, most states have lifted restrictions for advanced practice professionals like nurse practitioners. It is important to review state requirements and restrictions. This is an evolving situation daily.

Is telehealth covered by insurance?

Copays for telehealth depend on the health insurer and the telehealth platform. More than one-third of people in the United States currently have telehealth coverage through their insurance. Digital tool coverage is dependent on the payer but in the case of moderate-to-severe asthma, payers will pay if there is justification for remote monitoring.