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Battling Coronavirus COVID-19, Broadband Could Provide Relief Although Telemedicine May Not Help

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Photo of President Donald Trump, joined by Secretary of Health and Human Services Alex Azar and White House Chief of Staff Mick Mulvaney, listens as Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention, addresses a briefing on the COVID-19 coronavirus on Jan. 29, 2020, in the Situation Room of the White House, by Joyce Boghosian

WASHINGTON, March 6, 2020 – As cases of the novel coronavirus expand in the United States, Americans are struggling to address changes that have, or are coming, to their lifestyle.

Broadband connectivity may be an important factor in confronting the growing pandemic. However, the impact of telemedicine in dealing with the COVID-19 disease may be limited.

COVID-19 is mainly spread through person-to-person contact. As infections continue to spread in the U.S., self-isolation and growing quarantines are becoming more likely. These aspects of isolation could affect large communities of people – and perhaps until a vaccine is available in a year or more.

But in addition to being a test of medical emergency preparedness, the COVID-19 panic may also become a test of broadband access.

Indeed, while the digital divide has been a constant discussion point in Congress and at agencies like the Federal Communications Commission, an outbreak of COVID-19 could expose the harsh realities of entire communities left on the wrong side of internet access.

The impact of broadband upon confronting the COVIP-19 pandemic

Ten years ago, the National Broadband Plan was released. In 2020, many remain unconnected, creating both rural and urban digital divides.

Ironically, universal broadband could facilitate the connection and resources people need to survive and make due during quarantines that may be part of a broader outbreak of the COVID-19 pandemic.

Isolation would impact the ability to work, go to school, go to the doctor, go to church, and participate in everyday activities. Ultimately, broadband is the tool that can allow work from home, online school, telemedicine, and online worship.

While broadband can connect people to work, education and worship, without universal or widespread buildout, broadband only connects some of us.

Global response to person-to-person spread by curtaining public events and worship

The global COVID-19 death count is now more than 3,000, with more than 100,000 infested. Different countries and regions of the globe are taking different approaches to stem the spread.

BBC News reports that “France has banned all indoor gatherings of more than 5,000 people,” and even cancelled the Paris half-marathon.

Italy, the European country taking the brunt of COVID-19 so far, has organized zones depending on the situation of an area, reports Holly Ellyatt for CNBC.

Red zones are quarantined, but the “yellow zones” are engaging in preemptive cautions like closed schools, and “sports events and religious and cultural spaces have been postponed or canceled,” writes Ellyatt.

Steve Holland and Julie Harte, reporting for Sight Magazine, wrote that “churches closed in South Korea as many held online services instead, with authorities looking to rein in public gatherings.”

Tad Walch of the  Deseret News in Salt Lake City, Utah, reporting on global worship, reported that “from Italy to Singapore, congregations affected by the COVID-19 coronavirus outbreak either held virtual fast-and-testimony meetings on YouTube or Zoom or didn’t meet at all.”

Fast-and-testimony meeting refers to a service held the first Sunday of every month in the Church of Jesus Christ of Latter-day Saints. Across several countries, these worship services were either cut short or – in Italy – not held in person at all.

How telecommuting and tele-education are adapting to COVID-19

Rather than gather in large groups and risk the spread of disease, broadband technology is providing worship and connections that allow people to avoid potentially contaminated places.

For some professions, telecommuting could be a viable option to avoid infection.

Twitter announced on its blog that employees should be working from home across the world if feasible.

“We recognize that working from home is not ideal for some job functions. For those employees who prefer or need to come into the offices, they will remain open for business,” said Twitter.

However, Twitter said the company has already “been moving towards a more distributed workforce that’s increasingly remote.”

A Washington state school district cancelled school to “train employees on how to teach children remotely, should the outbreak worsen,” reports Mike Baker and Karen Weise for the New York Times.

But the “homework gap” may be exacerbated because many homes lack access to broadband. What will happen to schoolchildren in their broadband deserts?

“For families without laptops or internet access, the district was working to provide computers and internet hot spots,” report Baker and Weise.

A petition with over 10,000 signatures is calling for the University of Washington to close its campus, write Baker and Weise.

The implications of closing a major university for an extended period of time with over 45,000 students at the Seattle campus are devastating, for students and employees.

The impact of telemedicine upon COVID-19 will likely be more limited

Just as many in South Korea worshiped online rather than physically gather together, telemedicine could – theoretically – limit person-to-person contact, while still facilitating health access.

Using telemedicine, patients with access to broadband can communicate directly with their health professionals from their own home. This means patients do not have to travel to their doctor or risk catching something in the doctor’s waiting room.

Unfortunately, using telehealth to cope with COVID-19 is not so cut and dry, said Craig Settles, a broadband enthusiast and telemedicine expert.

“To do any type of examination for the virus, you need to have a device that allows you to hear the sound of [your] lungs,” said Settles. He said such a Bluetooth-enabled device allowing doctors to listen to a patient’s heart or lung sounds from a remote location does exist, although is not in widespread use.

Telemedicine would be a better option for regular patients once they have already acquired telemedicine equipment that he or she will use more than once, explained Settles.

Global Telemedicine Group President Jay Sanders said telemedicine has many benefits, but conceded that as COVID-19 is a disease that can “impact the lungs,” and patients may need initial assessments completed in a hospital or medical provider’s office.

“It may be very difficult, especially if the individual is complaining of shortness of breath, for a telemedicine physician to be able to make a determination whether this is COVID-19 or just a common upper respiratory infection,” explained Sanders.

The best scenario for telemedicine would be to “keep the patient in their particular location like their home and not out in a crowd” and “monitoring their symptoms,” said Sanders.

Sanders added that “continuous care can easily be provided through telemedicine.”

Assuming that a patient has access to technology and broadband connection, “the ease of use is your smartphone or your computer,” added Sanders.

Kim Almkuist, a family nurse practitioner in North Carolina, said that she currently provides telemedicine, but her community only has access to one Bluetooth-enabled stethoscope, meaning patients have to travel to the nurse who has the device, and then she can provide care from her location. Almkuist uses TytoCare devices.

Almkuist said it wouldn’t realistic for every patient to have the device, which can cost about two to three thousand dollars. However, if more communities had access to telehealth devices or positive, quarantined COVID-19 patients had the equipment, then they could receive quality telemedicine care.

“I do think that there is still a place for telemedicine, especially in a quarantine” situation, said Almkuist.

If you can afford the devices, then telehealth is useful, said Settles. Some states do not have “consumer-friendly telehealth” because “it’s not ensured the same way in every state,” said Settles.

Telemedicine still has not be widely adopted into our healthcare system, so it is not an affordable or practical option still for many people.

If telemedicine was widespread and a viable option in the event of a pandemic, then broadband access would be the first tool to facilitate health and safety.

What are the Centers for Disease Control and Prevention saying about COVID-19?

So far, the CDC has identified three symptoms of COVID-19: fever, cough, shortness of breath.

The CDC has identified various precautions to avoid contamination. Below a few are listed:

  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

Although the CDC warns that infection could occur from contaminated objects, “this is not thought to be the main way the virus spreads.” Ultimately, person-to-person spread is the main form of infection.

Health

Senate Subcommittee Hears Broadband Affordability, Regulatory Flex Key to Reducing Hospital Burdens

Health providers testified before a Senate subcommittee that Congress should be open to all forms of telehealth.

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WASHINGTON, October 7, 2021 – A Senate subcommittee heard Thursday that affordability is the greatest barrier to broadband adoption and that lawmakers should exercise regulatory flexibility when it comes to the forms of telehealth to help reduce inessential hospital visits.

Covid-19 often brings about extreme shortness of breath, the severity of which is best assessed by a doctor, Deanna Larson, president of Avel eCARE, told the Senate Subcommittee on Communications, Media, and Broadband, which convened a hearing on the state of telehealth and removing barriers to access and improving patient outcomes.

Patients with affordable, high speed internet access can be monitored at home by doctors so that they don’t enter an emergency room or take up a hospital bed prematurely, she said.

Larson urged Congress to extend or make permanent their regulatory flexibility toward telehealth especially as it relates to being neutral on the kinds of telemedicine, such as phone-only care, asynchronous care, and remote patient monitoring. An economic benefit of which would be keeping medical commerce local, she said. Patients wouldn’t be required as often to move to a higher level of care out of town.

Physicians would have 24-hour access to the patient through video calls, monitoring patients in a way which significantly lightens the burdens of the healthcare system, added Larson. With telehealth, doctors can advise patients on exactly when and if they need to go to an emergency room.

Steps to improve telehealth

The committee also heard testimony from Sterling Ransone Jr., president of the American Academy of Family Physicians. Ransone, a strong proponent of telehealth, has found that the digital divide touches rural, tribal and urban communities alike and proposed a series of steps Congress could take to increase public health through broadband policy, including investing in universal affordable broadband service, digital literacy services, end-user devices, audio-only telehealth and data collection in the determinants and outcomes of telehealth as it relates to key factors such as race, gender, ethnicity and language.

Defining broadband as a social determinant of health, Ransone highlighted that affordability is possibly the greatest barrier to broadband adoption and that affordability and access disproportionately affect rural communities.

Sanjeev Arora, founder of Project ECHO and distinguished professor of medicine at the University of New Mexico, agreed: “expanding access to high-quality, high-speed broadband connectivity is critical. It’s a prerequisite for the success of any telehealth model in rural communities and urban underserved areas.”

Telehealth isn’t just vital and broadly popular, it is cost saving. Federal Communications Commissioner Brendan Carr, who also appeared before the subcommittee, shared an estimate that widespread telehealth availability could save the health care system $305 billion a year.

Carr, in an effort to reduce inessential hospital visits and decrease the risk of spreading Covid-19, endorsed the CONNECT for Health Act, the RUSH Act of 2021, the Telehealth Modernization Act, and the Protecting Rural Telehealth Access Act, which in combination would remove geographic restrictions to telehealth services, foster use of telehealth in skilled nursing facilities, grant the Secretary of Health and Human Services greater ability to reduce telehealth restrictions and more.

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Expert Opinion

Craig Settles: Libraries, Barbershops and Salons Tackle TeleHealthcare Gap

Craig Settles describes the important role that community institutions have played in promoting connectivity during the COVID-19 pandemic.

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Photo of Urban Kutz Barbershops owner Waverly Willis getting his blood pressure checked used with permission

Today, Senator Ed Markey, D-Mass., Senator Chris Van Hollen,D-Maryland, and Representative Grace Meng, D-N.Y., led 40 members of Congress to introduce the Securing Universal Communications Connectivity to Ensure Students Succeed (SUCCESS) Act. The bill would extend the Emergency Connectivity Fund by five years and provide $8 billion a year to schools and libraries for student connectivity off-campus.

Barbershops and hair salons are long-time anchor institutions in African-American communities that have shown promise for advancing telehealth. Their partnering with libraries (a broadband anchor institution), and the Biden Administration’s enlisting of 1,000 shops and salons to help combat COVID-19, telehealth and public health in these communities could go into overdrive.

Missing their July 4 COVID-19 vaccination goals, the Biden Administration raised money to transform the shops into mini-medical centers. This success is motivating shop owners to do more. As one of the targets for $7 billion in broadband funds, libraries are idea partners that can provide broadband services, digital content, and digital and health literacy shops’ customers. 

Mike Brown manages a barbershop in Hyattsville, Maryland, and participated in the vaccination program. Brown and others owners talks with their customer about how the vaccines have been proven to work. “I use my platform to advocate for truth and dispel myths,” said Mr. Brown in an Wall Street Journal article, who has also held a vaccination clinic in his shop. “I’ve gotten about 60% of my clients to get vaccinated.”

The program has opened shop owners’ eyes to the power they have to make a difference in the healthcare of their communities. It’s a logical transition from the vaccination program to hypertension screening. Urban Kutz Barbershops in Cleveland have been screening customers for 12 years, recently with telehealth assistance from the famed Cleveland Clinic’s. 

Owner Waverley Willis says “Barbers and hairdressers are part-time marriage counselors, psychiatrists, spiritual advisers, and expert listeners. So many customers listen to our medical advice.” He has made a noticeable impact on many of his customers’ healthy eating habits as well.

Think differently about broadband, public health and telehealth

On July 1, the Federal Communications Commission began a 45-day Emergency Connectivity Fund of $7.1 billion in broadband and digital technology funding to support libraries and schools. By August 13, libraries interested in grants from the program must present a proposal on how they plan to spend money for libraries laptops, hotspots, Internet services, and other resources to advance education and remote learning. 

A generous interpretation of “education“ enables libraries to serve any patrons with broadband. If libraries are situated in areas in which there are no ISP services, they can request money from ECF to build their own broadband infrastructure for unserved patrons. Unlike traditional E-rate proposals, ECF doesn’t require a competitive bid for services, meaning libraries can present a quote from the first vender they contact.

Libraries partnering with shops and healthcare organization could give shops laptops, telehealth software, and portable hotspots to provide hypertension screening and other healthcare services that are suited to their customers’ needs up to three years. Shop owners often don’t have computing devices or Internet access in their shops. Telehealth devices such as portable digital blood pressure monitors and digital scales will have to be provided separately and possibly through funds from another government agency such as Health & Human Services.

For hypertension screening, for example, shops can take customers’ blood pressures digitally. The healthcare provider takes that data through telehealth and recommends treatment when necessary or advisable. The partner likely would have established rates for their healthcare services. Shops can then decide on additional telehealth services they want to provide.

The shops could work with libraries to develop health information and interactive Web content to reduce hypertension and other medical issues through healthier living, plus the libraries can provide telehealth services beyond what the shops can do.  

Libraries and shops can also designate customers who need a laptop, hotspots and telehealth software for chronic illnesses such as severe hypertension, diabetes, heart disease, mental health treatments, and so forth. However, these devices in this scenario would need to be given out for longer periods then just a couple of weeks. For occasional medical appointments, libraries can loan out laptops and hotspots for limited times such as two or three weeks. Libraries are good at delivering digital training and literacy programs.

Why barbershops, hair salons and libraries? 

Facilitating telehealth and healthcare does have an educational element for barbershop and hair salon customers as well as for general library patrons. These health services and information help both groups of people learn more about their own health, enables them to react effectively to medical issues, and be more proactive in taking care of their health.  

The ability for shops and salons to reach and impact African-American communities is legendary. “This type of barbershop health initiative has been shown to be effective,” said Cameron Webb, a senior White House health equity adviser on the coronavirus. Willis adds, “On more than one occasion, a guy’s blood pressure would be so high we would urge him to skip the haircut and go straight to the emergency room.”

The author of this opinion is municipal broadband expert and industry analyst Craig Settles.

Libraries have years of experience introducing new technology such as broadband to underserved populations. Matt McLain, Associate Director for Community Engagement at Salt Lake County Library, said, “We’ve had a pretty good amount of success reaching Hispanic populations at their markets. We have Asian markets out here too. And our health initiatives are quite important with the church leadership in these communities.”

The healthcare and broadband gaps are real and they are deadly! So many elements of the COVID pandemic reiterates the deadliness of those gaps. According to the Centers for Disease Control, of the data collected as of June 14 nearly two-thirds of people who got at least one dose of the vaccine were White. Only 9% were African-Americans. 14 million urban household cannot get any broadband, without which you cannot get telehealth, and 75% are Black or other people of color. 

There may never be as many federal broadband and health-related grant programs as we are seeing now. Partnership potential between libraries and haircare shops are many. Will public health practitioners and advocates, broadband builders, and community leaders step up?

Craig Settles conducts needs analyses with community stakeholders who want broadband networks to improve economic development, healthcare, education and local government. He hosts the radio talk show Gigabit Nation, and is Director of Communities United for Broadband, a national grass roots effort to assist communities launching their networks. He recently created a guide to help librarians uncover patrons’ healthcare needs, create community health milestones and effectively market telehealth. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to commentary@breakfast.media. The views expressed in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

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Health

Institutions Must Continue Riding Telehealth Growth Momentum for Post-Pandemic Care

Governments and health providers have an opportunity to carry the momentum of 2020 for telehealth’s future.

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Anthem President Gail Boudreaux

July 15, 2021 — The average healthcare organization completed two years’ worth of digital transformation during the first two months of the pandemic, according to IDC Health Insights data. This is only the beginning of telehealth advancement, and governments and health providers should continue to push for further development even after the pandemic slows, the Western Governor’s Association said in a virtual event last month.

The WGA launched its Western Prosperity Roundtable to work on policies such as telehealth and other technologies that have the potential to connect unserved and underserved communities.

While telehealth technologies have been gaining traction for some time, the past year led to a tremendous increase in usage. David Pryor, regional vice president and medical director for Anthem Inc., said that 2020 saw 80 times more utilization of telehealth than the year prior.

With the help of innovation, health centers were able to pivot from in-person care to digital. Digital kiosks have been implemented in states such as California to help improve specialty care and decrease language barriers. These kiosks give patients access to cameras put them in touch with healthcare professionals for important services including mental health.

Empirical experiences

In one experience that Pryor shared from a frontline women’s health clinic in California, a deaf patient came in for an exam and the clinic was able to utilize the video feature with a sign language interpreter on the digital kiosk. “The patient started to cry because she [had] never had such a caring visit,” Pryor said.

Technology advancement has created opportunities for those that previously were overlooked, including rural communities that were forced to commute long distances to receive healthcare and urban centers that lacked options.

The WGA aimed for the panel to push state legislators to continue increasing healthcare access for their constituents through digitalization.

Some states have established their ongoing commitment to telehealth already. In a statement released in August 2020, the Governors of Colorado, Nevada, Oregon and Washington shared their goals to support telehealth services for residents of their states. “Telehealth is here to stay.” they wrote. “We will have individual state-driven approaches to implementing telehealth policies, but our work will be guided by seven overarching principles: access, confidentiality, equity, standard of care, stewardship, patient choice, and payment/reimbursement.”

Over the course of the pandemic, Congress has created and helped fund several programs, many of which focus on telehealth, programs to help accelerate broadband deployment across the country in efforts to connect minority communities, Tribal lands, and other qualifying households.

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