In the spring of 2020, the coronavirus pandemic first gripped the world by the throat and its deadly menace continues to unfurl with renewed ferocity. In the United States, medical and scientific experts issued a series of early recommendations to slow or halt the spread of the virus that causes the disease COVID-19. Such public health measures are clearly warranted. As of this writing, over 285,000 Americans have perished from COVID-19 and the infection numbers are soaring across much of the country. Recommendations to combat the virus spread include handwashing, covering the face when coughing and sneezing, wearing a mask when in public spaces, and social distancing. The most challenging anti-virus measure was the lockdown or stay-at-home orders issued by state and local governments. In many communities, people rushed out to stock up on food, water, and household supplies before they began sheltering in place. The lockdown preparations and implementation clearly highlighted the pervasive and persistent inequalities impacting every aspect of American life that are attributable to social determinants of health (SDH). The World Health Organization defines SDH as “the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.” During the current public health crisis one key question for researchers, policymakers, and clinical providers alike to ask is: Which populations in the U.S. are most likely to experience adverse effects from SDH?
As an academic nurse researcher with expertise in health disparities, I closely monitored news about how the spring lockdowns were impacting various population groups. I paid special attention to the dramatically different experiences of white-collar employees, many of whom had the privilege of safely sheltering in place while working from home, and front-line essential workers who had no such option. This later group, often employed in grocery stores, meat-packing plants, bus stations, and other crowded environments, had higher risk of exposure to the coronavirus. Many of these essential workers are people of color and the devastating consequence of this reality was all too predictable. According to the U.S. Centers for Disease Control and Prevention, communities of color have experienced considerably higher rates of infection, severe illness, and death from COVID-19. This population includes approximately 100,000 individuals, largely African American, with sickle cell disease (SCD), an inherited red blood disorder. The major symptom of this disease is persistent, disabling pain, including excruciating episodes known as a pain crisis. SCD is a lifelong illness with a life expectancy of 48 years for women and 42 years for men.
With a primary research focus on pain management disparities experienced by SCD patients, I worry how coronavirus-related stressors are exacerbating the considerable pain already endured by these individuals. My research indicates that systematic stressors such as healthcare injustice—defined as unfair treatment an individual receives from important medical figures such as healthcare providers — predicts increased pain in patients with SCD. They are particularly vulnerable at this time because the coronavirus pandemic can magnify the negative SDH already experienced due to their race and disease trajectory.
I am concerned about how SCD patients are coping with today’s magnified societal stressors, particularly when trying to avoid a stress-related pain crisis that would require hospitalization and potential exposure to the coronavirus. Given the comprised hematologic profile of patients with SCD, which reduces oxygen circulation, these individuals are at elevated risk for both COVID-19 severity and mortality. Statistics from early in the pandemic document this grim reality. A recent study found that between March and May 2020, 178 infected individuals were entered into the SCD-coronavirus disease case registry. Of these, 122 (69%) were hospitalized and 13 (7%) died. (These hospitalization and death rates are much higher than for infected individuals in the general population.) Healthy stress management techniques that decrease emotion-triggered pain crises could greatly improve the well-being of SCD patients and potentially reduce their hospitalizations and deaths. Healthcare professionals can play a key role in encouraging patients to consistently utilize non-drug coping strategies to complement medication regimens for pain management.
Our research team found that patients with SCD who experienced healthcare injustice from nurses reacted to this psychological stressor by isolating themselves. Meanwhile, those who experienced healthcare injustice from doctors reacted by both isolating and pain catastrophizing. These negative coping strategies are associated with poor health outcomes. For example, pain catastrophizing corresponds to lower health-related quality of life for patients with SCD. On a more positive note, patients who experience healthcare justice also cope with prayer and hopeful thinking. These healthy strategies have long been endorsed within African American communities, where deep spiritual beliefs and regular religious practices have helped them deal with the harsh realities of slavery and the systemic racial discrimination and injustice that sadly remains a powerful force in American culture.
Another coping strategy for SCD patients dealing with stress and pain is guided relaxation. This can include deep breathing and counting backwards from 10 to 1 while focusing on a specific spot within an object. This technique has been shown to effectively reduce stress and pain for adults with SCD. Another recent study found that music therapy also reduces pain and improves mood. It is important that these vulnerable patients know there are a number evidence-based drug-free strategies they can utilize during this unprecedented and pressure-filled coronavirus pandemic.
Unfortunately, SCD patients in the United States, like other citizens the world over, cannot individually control the course of the pandemic and the havoc it is wrecking. However, these patients do wield tremendous control over how they choose to cope with coronavirus-related stressors that can intensify their SCD pain. In addition to the non-drug options described above, individuals can explore and try other safe coping strategies to better manage their physical and emotional health challenges. It is vital that patients are proactive on an ongoing basis to reduce their stress and pain and improve their overall well-being as the world awaits better coronavirus treatments and an effective vaccine.
I’m doing laundry at a wash & fold in front of the house boats of Sausalito. Reminder: buy more scrubs. I’m one mile from from the hotel. Three minutes by car, 10 minutes by bicycle. The views are great. The weather is awesome. I could live here easy. Not on a house boat though.
They have a problem with the mating calls of some kind of small mud fish whose population has exploded. I guess it sounds terrible, like hammers on the hull all night long. Nature.
The hotel is a popular national chain brand in Mill Valley, gateway to Mount Tamalpais, and Muir Woods. It’s just north of San Francisco. I can just barely see Coit Tower. I’m maybe an hour and a half from my home so the commute would be brutal. The state is picking up the hotel tab thanks to a program authorized by the governor. It’s been a godsend.
The hotel is using the pandemic money to remodel. The room is nice, but there are sawzalls and hammers and loud Mariachi music playing during the day. At least I’m hardly ever there. They don’t clean the rooms as often because of the pandemic, but you can get fresh towels and coffee pods at the front desk any time.
The job is tedious, but not difficult. Basically, you make rounds on the prison population two times daily trying to root out COVID patients and separate them. I get there at 5:30 AM. There is a line to get through the gate. I have to sign four different log books in four different areas plus clock in with a time card.
We got a great tour of the prison on day one. The thing I remember the most is when the nurse educator guiding us said, “To everyone else they are prisoners, to us they are patients…all of them.” This dichotomy in mandates between prison staff and medical staff has allowed me to put the job neatly into my bailiwick. Nursing is nursing. The rest of it is for prison staff to handle.
The whole prison is on lock down. It’s quiet in the yards. It’s been grim. However there is hope. The numbers are improving. On my first day, there were over 1,300 patients in isolation. Two weeks later, the number is half of that. Everyone wears a mask. Infection control is taken seriously. Teams of nurses go out twice daily to assess the inmates. Other teams are doing COVID testing. Every staff member gets tested once per week. Cautiously, things are returning to a semblance of normalcy, whatever that means in a prison.
We pair up—an RN and an LVN—and grab our shoulder bag. Inside the bag is an IR thermometer, a pulse oximeter, a BP cuff, disposable PPE, alcohol wipes…sundries. When we get to our assigned area we put on the PPE and each team gets their own guard to keep them safe. “Don’t step into the cell, don’t put your face in front of the food port, don’t walk close to the cells…” Helpful advice and a sober reminder of the overlapping existence of prisoner and patient.
I’ve given careful thought to the nature of the job, the nature of crime and punishment, and the morally ambiguous task of providing competent health care to people who have committed terrible crimes. Thankfully, I’ve never followed crime stories. Having worked in the ER for many years, I’ve dealt exclusively with the aftermath of crime and the amelioration of its physical consequences…as best as can be done anyway. I have no curiosity about death row inmates. I can honestly say that I leave that at the door and look at each person strictly through the lens of health care. Having said that, I can tell from even the most cursory interactions with some of the patients that there are some seriously disturbed people within these walls. I’m happy to move along to lower level offenders.
From the ground, I can say the efforts to control the spread of COVID within the prison have been very successful. Again, I’m just the tip of the spear so the big picture is a little out of my view. But just judging from the numbers of patients I assess daily, things are improving very quickly. I guess that’s the benefit of working within a closed system…it was also that closed system that allowed the virus to spread so quickly in the first place, so there’s that. Wearing masks, social distancing, testing, contact tracing, quarantining…they have brought the cases of infection down so quickly that it’s possible that the job will end early. I’ll be sorry to leave. The pay is…generous.
The best part of the experience has been meeting new friends. Travel nurses are go-getters. I’ve met nurses from all over the world on this assignment. We share a common bond and have moved together from trepidation to confidence in this new role. We share stories in the break room and compare notes on our experience. Several nurses are staying in the same hotel that I am. It’s a great way to meet friends in our new socially isolated world. I hope that I have met lifelong friends here as I have on other contracts. The staff at the prison have been nothing but welcoming, same for my agency. A good experience from top to bottom.
The good news…or bad news depending on how you look at it, is that other prisons are experiencing similar outbreaks and will need COVID crisis teams to come in. There are already jobs being posted for other prisons in California. Susanville, San Lois Obispo, are two that I’ve seen. If you are interested in making some quick money, and are willing to shoulder some risk, I encourage you to contact a recruiter. The turnaround time for me was three days between first contact and clocking in. Be ready to move quickly. Have your documents together. The free hotel program is still in effect so your housing is covered. Stay safe out there.
If you hadn’t heard of telehealth before the coronavirus pandemic, you probably know about it now. Medical providers are trying to move as many of their appointments to virtual means as they can. While telehealth options have been around for years, this is the first time it’s been implemented on such a wide scale. Since many people want to know exactly what telehealth is and how it works, we answer all your telehealth FAQs. Ever wonder about security concerns and how providers diagnose symptoms like the coronavirus via video call? We’ve got you covered.
What types of telehealth are available?
There are three main types of telehealth interactions that you might have with your provider. They are:
Live consultations, which are usually held over video conferencing.
Asynchronous messaging, where you send your provider text or pictures and they respond as they are able.
Remote monitoring, when the patient uses at-home devices to measure vitals such as blood glucose and then sends them to a provider for an examination.
A telehealth appointment usually refers to the first option, i.e. scheduling a video call with your provider (white lab coats and nursing scrubs not required), but your telehealth interactions will usually span all three categories.
Is telehealth secure?
Given all the privacy concerns surrounding technology, many people are understandably concerned about the security of their virtual visits. The security will vary depending on the service(s) that your provider uses. If your doctor is part of a larger hospital network, they may contract with a major telehealth provider or use a proprietary system, which should be more secure. Smaller practices may use more general-purpose virtual meeting software, such as Skype, which usually have looser privacy restrictions. Investigate the privacy policies of the services that your provider asks you to use, and you can also ask your provider about implementing security features such as encrypted data transmission.
Is telehealth covered by insurance?
This depends on your insurance, your provider, and the telehealth system they use. In general, telehealth services provided directly by a doctor or a hospital are more likely to be covered, though not always. Even if the virtual visit is covered by insurance, patients may still have a co-pay or another charge. If it’s not covered, patients can choose to pay out of pocket for the entire visit. Common per visit fees range from $50 to $80, while other platforms charge an annual membership fee. If you’re on Medicare or Medicaid, thanks to some recent changes, Medicare will cover telehealth services and Medicare Advantage plans may waive or reduce cost-sharing.
How can I find a telehealth provider?
If you already have a provider, check with them first to see if they have existing telehealth or upcoming telehealth options due to coronavirus. Depending on what insurance you have, you might also be able to filter your provider search on the insurance portal to only show providers that provide telehealth options. Some telehealth service websites, such as Teladoc Health and MD Live, will let you search for providers on their website. If you find doctors via the latter route, you’ll need to contact their offices to see if they accept your insurance before you make an appointment.
What are some advantages of telehealth?
Telehealth offers several benefits over regular appointments. For one, it protects both patients and providers from the transmission of germs (very important in the age of coronavirus). It also eliminates the need to secure transportation and elder or child care. Plus, it reduces the time spent in waiting rooms and on the road. Telehealth appointments save patients and providers money as well as time. They also give providers more flexibility to set their own schedules and schedule appointments when it’s most convenient for everybody involved.
What are some disadvantages of telehealth?
However, telehealth does have some drawbacks. Obviously, some visits simply need to be completed in person. Patients can’t just grab a stethoscope and listen to their own vitals. There can also be issues of access, as not everyone has a smartphone or laptop and a stable internet connection, which are necessary for video consultations. The inconsistency of insurance coverage for patients and reimbursement for providers can also cause headaches and complicate what would ordinarily be a simple visit.
Can I get a prescription via a telehealth appointment?
Yes, doctors can use telehealth to write or renew prescriptions. If you just need a refill on an existing prescription, you might be able to request it by messaging your doctor and eliminating the need to book and pay for an appointment. If it’s a new prescription, or you’re not sure what medication you need, you’ll probably need to book a quick appointment for a diagnosis. They’ll still have to call in the prescription at a local pharmacy, so you’ll have to venture out to pick it up or arrange to get it delivered.
Can coronavirus be diagnosed via a telehealth appointment?
Because the symptoms can vary so widely from patient to patient, and also overlap somewhat with those of other common infectious diseases (including the flu), the only way to confirm that you definitely have coronavirus is to get a test that involves taking a swab in person. However, you can use a telehealth appointment to discuss your symptoms with your doctors and determine whether you need a test or if you’re just suffering from allergies. In fact, many hospitals have set up a coronavirus hotline specifically for this purpose. Your doctors can also talk you through quarantine best practices and how to keep those around you safe.
If you need to talk to your doctor right now, odds are that you’ll be making your visit virtually via telehealth services. Keep these FAQs in mind to make sure that your visit is covered by insurance and your privacy is secure. Welcome to the future of medicine!
Telehealth has slowly been making inroads over the past couple of decades, and the spread of the coronavirus pandemic has only escalated its adoption. Doctors have been told to hold every visit possible remotely in order to cut down on the chances of spreading the virus between patients and medical providers.
While in-person doctor’s visits have been the standard for generations, telehealth offers several benefits that in-person appointments simply can’t match. In fact, telehealth can reduce costs and barriers to access for both doctors and patients. If you’re new to the idea of telehealth, here are nine benefits that you need to know about remote health care.
1. You don’t have to worry about transportation.
Getting to and from the doctor’s office can be a large barrier. Even people with reliable vehicles have to make arrangements with their households to use the car, as well as taking both travel time and gas into account. Patients who use public transportation or ride-sharing options have to account for many more unknowns, including unreliable transit schedules and routes that may not take them directly to the doctor’s office. By letting you stay in your home, telehealth visits make it easier to talk to your doctor and increase access to care.
2. You don’t have to find elder or child care.
For adults serving as primary caregivers, getting away from the house can be tough, even if they’re not officially employed. In that case, they have to arrange for their partner to stay home, or if that’s not possible, find or hire other people to watch their children or parents while they go to the doctor. This added expense and hassle serves as a barrier that keeps people from getting to the doctor’s office. Remote health appointments remove the need to find elder or child care for dependents, making it easier to virtually visit the doctor.
3. You’ll waste less time.
Time is a major consideration in scheduling and attending doctor’s appointments. You have to factor in not only the length of the appointment itself, but also transportation time and time spent in the waiting room. Between everything, many patients must sacrifice two or three hours of their day just to talk with their doctor for 15 minutes (or less!). Some people simply can’t get that much time off of work, which makes them reluctant to visit the doctor. Remote appointments eliminate transportation time and significantly reduce delays as well. No more wasting an hour in the waiting room while the minutes tick past your appointed time.
4. It reduces your chances of catching an illness.
We’ve all had the experience of sitting in a waiting room during cold and flu season, listening to other patients around us coughing and coughing and coughing. Simply due to the concentration of sick people, in-person doctor’s offices increase the odds of spreading germs. Plus, if you’re already visiting the doctor because you’re sick, your compromised immune system can make you more vulnerable to picking up more germs. Taking appointments from the comfort of your own home keeps you safe and prevents you from spreading any potentially contagious illness to other people.
5. It’s increasingly covered by insurance.
More and more insurance companies are covering telehealth visits, and as the cascading effects of coronavirus encourage more processes to move online, this trend will only continue in the future. While once considered a luxury, remote doctor visits will soon become as mundane as visiting a typical office for both you and your insurance company.
6. You can see more patients.
Because of the increased efficiencies and reduced downtime between appointments, telehealth systems allow you to see more patients that you otherwise would not. Some physicians also use the time they would have spent commuting to extend their office hours, letting them see even more patients. For example, some patients who can’t get off work during the day might be able to hop on a call with you at night for half an hour. (And none of them will know if you’re wearing pajama pants under your white lab coat.)
7. You don’t have to leave your house.
Many of the same benefits that apply to patients are also a boon to physicians. Staying at home eliminates health care providers’ commutes, which saves time and money that they can use to see more patients. Telehealth doesn’t just limit patients’ exposure to germs. It also limits physicians’ exposure, which keeps them healthy and eliminates the chance that they might carry germs between patients. Finally, telehealth visits can ease the burden on physicians and their families who are also caring for children or relatives at home.
8. It reduces costs.
By increasing the number of patients and decreasing overhead expenses, telehealth visits save money. These savings are especially important for physicians who own their own practices instead of working for a big hospital. While you might need to initially invest in setting up or subscribing to a secure telehealth system, remote visits will quickly pay for themselves as they become more popular. In fact, telehealth might actually open new opportunities to bill for activities that were previously uncompensated, such as follow up phone calls.
9. It improves patient engagement and reduces no-shows.
A doctor’s primary goal is to improve patient outcomes, and telehealth can accomplish this on several levels. Unfortunately, the patients most in need of doctor visits are often the ones who struggle the most with getting time off work, finding elder or child care and securing reliable transportation to and from the doctor’s office. Telehealth can help break down these barriers and result in a wide variety of benefits like reducing no-shows and diverting unnecessary visits to the ER. Ultimately, all these benefits ease the strain on the whole health care system.
Now, don’t hang up your nursing scrubs quite yet. There will always be a need for in-person doctors’ visits. But incorporating a telehealth option into your practice can benefit both you and your patients greatly.
The Center for American Progress recently published a piece by Connor Maxwell about how people of color have a greater risk of getting the coronavirus because of structural racism.
Maxwell, Senior Policy Analyst for Race and Ethnicity Policy, Center for American Progress, took time to answer our questions about how and why this is occurring as well as what nurses and other health care workers can do to help.
Why are people of color getting the Coronavirus at higher rates than their white counterparts?
Inequality is magnified in times of national hardship. Occupational segregation has concentrated people of color in frontline essential jobs in industries such as food processing and retail, health care, sanitation, and transportation. Housing segregation has also largely restricted people to densely populated urban areas where crowded grocery stores, public transit, and laundromats are common. Together, these factors contribute to increased racial disparities in coronavirus exposure and infection rates.
Please address the issues with social distancing as well as the economic, health care, and housing systems and how they are contributing to people of color being at greater risk for contracting the virus.
Social distancing is much more difficult for people experiencing occupational, domestic, and urban crowding. People of color are more likely to work in busy food processing plants, grocery stores, and other facilities where maintaining proper social distancing is almost impossible. They are also more likely to live in densely-populated urban areas with less spacious housing and multiple generations under one roof. These factors, combined with insufficient access to accurate and timely information about coronavirus and free testing and treatment, can increase the risk of contracting the virus.
What can state and local governments do to help reduce the risk for people of color?
Here are a few things that state and local governments can do to help reduce the risk for people of color:
Ensure adequate testing and treatment in areas most vulnerable to the virus.
Ensure the collection of demographic information upon testing citizens.
Establish a taskforce at the state level to monitor trends and provide guidance on how to reduce the racial disparities in their state.
Is there anything that nurses and other health care workers can do in order to help reduce the risk for people of color getting the Coronavirus?
Nurse and health care providers need to ensure they are equitably testing individuals coming in seeking health care. They should also support information about COVID-19 being translated in multiple languages so that all patients have access to relevant and important information about how to protect themselves against contracting the virus.
What else is important for nurses to know about this?
Contracting coronavirus is not the fault of individual actions or behavior, but of structures and systems that increase exposure and limit social distancing in communities of color.