As of May 12, only 16 people in Greene County had officially tested positive for COVID-19 with two hospitalized and one death, according to the Virginia Department of Health.
During the coronavirus pandemic people have been concerned about going to doctors’ offices and the hospitals. The first thing anyone should do if they exhibit any of the telltale symptoms of COVID-19 is to call their doctor’s office for a consultation. Depending on the described symptoms, they might then be advised to participate in a video call with the provider or to go immediately to the nearest emergency room for testing.
But what about those who are experiencing medical issues unrelated to COVID-19?
“If somebody feels terrible, the last thing they’re going to do (is go to the hospital), because they’re scared to death,” said Linda Copeland, local emergency nurse practitioner. “They’re thinking, ‘if I don’t have it right now, if I go there I could get it,’ and those are valid concerns.”
For those with serious medical concerns, visiting a doctor has become a logistically difficult and nerve-wracking prospect.
“Not all doctors’ offices are open all the time,” Copeland said. “And if a patient feels bad at five o’clock in the afternoon and they say it’s too late to call the doctor, and they deteriorate over the next eight hours, it goes from something that could have possibly been dealt with to patients getting into trouble very, very quickly.”
Copeland herself has been sick recently and since she was unable to get tested for COVID-19, she took advantage of telemedicine in order to consult with her doctor from a safe distance.
“While I had previous doctor’s appointments scheduled, they called and asked me to participate in telemedicine,” she said. “They had two ways of doing it, either over the internet or via smartphone, and I chose the internet because out here the connection for cell phones is very poor.”
In many areas of Greene County, poor cell phone reception and the lack of broadband internet access makes telemedicine visits impossible for sick residents.
“I have to admit it was a terrific experience,” Copeland said. “I could see my physician, she could see me, we could discuss everything; it was totally confidential. She was in a separate location with the door closed and obviously I’m at home, and together we worked out a plan for how we were going to deal with my issues. (But) if an individual does not have broadband, depending on who your provider is, you may or may not be able to actually have that encounter.”
Copeland, who first became interested in telemedicine while studying at Columbia University with its diabetic patient initiatives, has firsthand experience with the emerging technology at UVA’s telemedicine program both as a provider and now as a patient.
“When you look at the state maps for the penetration of broadband, it’s basically absent in this area, so it is a big problem until this broadband issue is really tackled by the supervisors,” she said. “I think (COVID-19) has really proven that we need this.”
The Greene Care Clinic in Stanardsville transitioned to “phone only” appointments beginning March 16 in order to protect the safety of its all-volunteer medical team, staff and patients.
“In medical school we were taught that 90% of the time a diagnosis is made based on history,” the clinic’s Medical Director Dr. Mary Preston said. “Listening carefully over the telephone, it is possible to make an assessment of the problem and develop a plan. But you say what about facial expressions and nonverbal cues? That takes very careful listening. Does the person pause or sigh? Is the speed of their conversation rapid or slow? Do they have a worried tone or are they dismissing serious symptoms?”
Since the transition to phone appointments, the clinic has seen and treated a variety of everyday problems from high blood pressure and cholesterol to sinusitis, bronchitis, anxiety, back pain, depression and diabetes.
“There have been a small number (of patients) with possible symptoms of COVID,” Preston said. “They were referred for appropriate evaluation.” Any patients with concerns over possible COVID-19 symptoms can be evaluated over the phone by the Greene Care Clinic to determine if they should be referred for respiratory testing.
Telemedicine does have limits. If a patient with high blood pressure has no way of measuring that at home, a doctor will not be able to test that over the phone. If they are wheezing, the doctor cannot use a stethoscope to check the lungs.
“But we can send patients to UVA and Sentara Martha Jefferson for lab tests,” Preston said. “We can refill prescriptions. We can send patients for X-rays at (Sentara’s) Proffitt Road location. We can refer patients to specialists. We can help patients apply for Medicaid Expansion or UVA’s financial discount.”
In mid-April, the clinic received funding from the Charlottesville Area Community Foundation’s Community Emergency Response Fund to purchase two laptops for the purpose of setting up video-enabled telemedicine with patients.
“Our two new computers just arrived, so we hope to begin scheduling telemedicine appointments in several weeks once our medical providers become trained and are comfortable with the software,” said Pam Morris, executive director of the Greene Care Clinic. A doctoral student is working with the staff to develop a tutorial for medical providers on the new software.
“Telemedicine will give our patients a way to communicate ‘face-to-face’ with our medical providers,” Morris said. “It might also be more convenient for some of our patients who have transportation challenges or help those who can take a short break from work but do not have the time to drive to our office.”
The clinic plans to keep the telemedicine option available even after the clinic is able to open its doors to patients again.
“It will be especially useful for follow-up appointments with patients where our providers don’t need to recheck a patient’s blood pressure or other health parameter in person,” Morris said.
As for those patients for whom internet access is a concern, telephone appointments are still available as an alternative to driving to one of the open doctor’s offices in Charlottesville.
“Internet access will certainly be an issue for some of our patients,” said Morris. “The telemedicine app that we will use can be downloaded to smartphones, tablets, laptops or desktop computers. If the patient would rather connect with a provider via telemedicine and not a phone appointment but they do not have sufficient connectivity to support the telemedicine platform, the Greene County Library at 222 Main St. in Stanardsville has free WiFi access 24 hours a day from their parking lot.”
The telemedicine platform in use by the Greene Care Clinic is HIPAA compliant; it uses security and encryption protocols to ensure patient data integrity and privacy and is the same program currently in use by many hospital systems.