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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

Digital Literacy Training Needed for Optimal Telehealth Outcomes, Healthcare Reps Say

Digital literacy should be a priority to unlock telehealth’s potential, a telehealth event heard.

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Photo of telehealth consultation from Healthcare IT News

WASHINGTON, May 18, 2022 – Digital literacy training should be a priority for providers and consumers to improve telehealth outcomes, experts said at a conference Tuesday.

Digital literacy training will unlock telehealth’s potential to improve health outcomes, according to the event’s experts, including improving treatment for chronic diseases, improving patient-doctor relationships, and providing easier medical access for those without access to transportation.

Julia Skapik of the National Association of Community Health Centers said at the National Telehealth Conference on Tuesday that both patients and clinicians need to be trained on how to use tools that allow both parties to communicate remotely.

Skapik said her association has plans to implement training for providers to utilize tech opportunities, such as patient portals to best engage patients.

Ann Mond Johnson from the American Telemedicine Association agreed that telehealth will improve health outcomes by giving proper training to utilize the technology to offer the services.

The Federal Communications Commission announced its telehealth program in April 2021, which set aside $200 million for health institutions to provide remote care for patients.

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Expert Opinion

Craig Settles and Sean Gonsalves: Telehealth For All is a ‘Stroke of Genius’

Without access to a secure broadband connection, the co-author of this Expert Opinion would have died.

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Craig Settles (left) and Sean Gonsalves are the authors of this Expert Opinion.

My colleague Craig Settles likes to say he had a “stroke of genius” when writing his last book about building the gigabit city. “I literally had an ischemic stroke at 10:30 p.m. on a Saturday night,” he recalls. “If I had been in a low-income urban community with poor communication infrastructure, or in a rural area with bad broadband, I’d probably be dead.”

The “genius” part was realizing broadband is magic that directly or indirectly enables us to perform minor and major miracles that we could not do before, but faster and easier.

When Craig moved to Alameda, California, situated less than five miles from the heart of Silicon Valley, he could not get cell service without a signal booster, and even then it was sketchy. Several years later the service was better, which allowed him to speed-dial his best friend who called 9-1-1.

The neurologist who set up the stroke center in Alameda Hospital had mirrored much of its technology and servers in her home so she could see everything the ER staff was seeing as they administered life-saving procedures within 25 minutes of Craig’s gurney hitting the ER door.

While Craig counts his blessings, over 14 million urban households do not have broadband in their home – 75 percent of whom are African American and other people of color. Millions more technically have home Internet service but don’t have the connection speeds and capacity to use the applications needed for remote work and school, or telehealth.

And don’t forget the 4 million rural homes that do not have broadband subscriptions.

Broadband as Social Determinant of Health

The essential nature of broadband came to the fore with the onset of the pandemic. And it compelled states and local communities across the nation to take the connectivity crisis far more seriously, especially with the influx of federal funds from the American Rescue Plan Act and the Infrastructure Investment and Jobs Act.

Although advocates commonly, and understandably, tout the importance of broadband access in the context of remote work and schooling, what often gets overlooked are the transformative powers of telehealth and its potential to drive broadband adoption.

It’s no exaggeration to say that broadband is a major social determinant of individual health as it enables access to virtual healthcare and facilitates a host of other things critical to health, such as education, employment, housing, and social services, all of which require broadband, most especially for telehealth applications.

More than video chats with your doctor, telehealth uses high-speed Internet connectivity to observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record, and/or report on the continuum of care. Public health, in particular, can leverage telehealth to a great advantage.

Yes, healthcare providers are increasingly integrating telehealth into the delivery of care. But, if the patients most in need of better access to healthcare do not have access to broadband, as well as computing devices and digital skills, tremendous healthcare benefits and cost-savings will be needlessly missed.

This suggests that “fiscally conservative” elected officials, many of whom claim to support universal access to broadband while lamenting the high cost of healthcare, have been thinking about this whole thing backwards. Instead of wailing about the cost of building universal robust broadband infrastructure that could be used for telehealth, why not flip the script?

Achieving universal broadband infrastructure that would last a lifetime would cost on the order of $100 billion, which is just two and a half percent of what we spend on healthcare in this country every single year. Hundreds of academic and industry studies say that even the most conservative telehealth initiatives save more than two and a half percent of system costs.

Talk about a return-on-investment! A hint of this can be seen in a study done by the National Center for Biotechnology Information which found there were as many as 3.5 million potential preventable adult inpatient hospital stays in 2017 alone. That amounted to $33.7 billion in health care costs just for that year.

Telehealth can eliminate many of those stays. And in terms of improving health outcomes, the study further found that the elderly, men, Black communities, and those insured with Medicaid would reap the biggest benefits.

So why not exploit the math, and pay for broadband using healthcare savings? Let’s connect every home, hospital, and community anchor institution in the country to robust broadband, and transform healthcare while bringing it into the 21st century. The municipal broadband model in which local communities build and own the infrastructure is ideal.

Telehealth Can Drive Broadband Adoption

Looking at it this way, universal access to telehealth has the potential to simultaneously solve the connectivity crisis and ensure that millions of families can lead healthier lives.

Here are six tactical ways of using telehealth to maximize public health in a community along with increasing broadband adoption.

  1. Re-inventing the doctor’s office visit for a variety of healthcare practices

Understanding telehealth, all you need are four walls, an Internet connection, a computer, a healthcare partner, and a healthy imagination to create a range of practical telehealth solutions.

Transform barbershops and hair salons into Covid vaccination and hypertension screening centers. The school nurse’s office can now become school telehealth centers. Libraries are starting to add telehealth kiosks.

Libraries Without Borders uses interactive Web health content, laptops, and wireless gear to outfit intercity laundromats on Saturdays. Tucson used ARPA funds to build out a wireless network on top of the city’s fiber infrastructure and gave 5,000 low-income homes the ability to have telehealth resources.

  1.  Telehealth can marry chronic healthcare, home care, and public health

Frederick Memorial now distributes hundreds of tablet computers for remote patient monitoring  in patients homes to check their vital signs, changing medical conditions and treatments, with data that goes to the hospital daily.

Urban hospitals should partner with ISPs to leverage the FCC’s Affordable Connectivity Program subsidy of up to $30 per month for Internet service and up to $75/month for households on Tribal lands. ACP also offers a $100 discount on computing devices.

  1. Enhance the emergency response and Emergency Department to save more lives and money.

African Americans and other populations of color have the highest rates of strokes, heart attacks, and other medical trauma. We could reverse the trend of hospitals that abandon poor urban communities and replace them with city telestroke or telehealth critical care “broadband subnetworks” that are hosted by major hospitals and linked to Federally Qualified Health Center, clinics, and other facilities.

  1. Expand efficiency of mental healthcare delivery

Mental health professionals getting to see patients in their homes and therefore providing an alternative to needing to go to a therapist’s office can not only eliminate no-show appointments but can provide those most in need of therapy with broader access to a variety of specialists.

Leveraging telehealth can be especially empowering for underserved communities in which approximately 30% of African American adults with mental illness receive treatment each year, compared to the U.S. average of 43%, according to the National Alliance on Mental Illness.

But as Carly McCord, Director of Clinical Services at the Texas A&M Telehealth Counseling Clinic, rightly points out: “Often we’re talking about intensive therapy, like treating PTSD, which you can’t do with crappy Internet connections. When your patient’s disclosing a trauma and your connection glitches, or you miss a word and have to say, ‘I’m sorry. Can you repeat that? ‘This is a huge problem.”

  1. Improving senior care and facilitating aging in place for our nearly 60 million seniors

Three-in-four older Americans want to stay in their homes and age in place, according to a AARP survey. And, if offered a choice, about 53 percent of respondents say they would prefer to have their health care needs managed by a mix of medical staff and healthcare technology.

A key broadband element in this telehealth equation is “smart home” technologies that include wirelessly-controlled sensors. Some sensors now can determine whether a person sat up in bed or actually fell on the floor, if patients are eating regularly, or if they are taking their medications on time.

  1. Re-imagining what hospital care can be

In areas prone to natural disasters, make prior arrangements with hotels, college dorms, warehouses, and other facilities where you can bring in generators, computers, telehealth equipment, and wireless intranets.

Use these buildings for seniors with health conditions who have been displaced: people with chronic illnesses and patients with non-serious injuries from the disaster should those people not have easy access to other residential or healthcare facilities.

Building and subsidizing access to robust community-owned broadband networks is a wise investment because it will improve health outcomes and return significant community savings for decades to come.

And with a flood of federal funds available to build broadband infrastructure and advance digital equity, we have a once-in-a-life opportunity to stitch this all together and deliver telehealth for all.

Sean Gonsalves is a Senior Reporter, Editor and Communication Team Lead for the Institute for Local Self Reliance’s Community Broadband Networks Initiative. Saved from a stroke by telehealth, Craig Settles pays it forward by uniting community broadband teams and healthcare stakeholders through telehealth-broadband integration initiatives. 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 reflected in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

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Health

‘Ample Evidence’ Telehealth Contributed to National Covid Response: FCC Commissioner Starks

Geoffrey Starks said adoption of telehealth services has ballooned during the pandemic.

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Photo of FCC Commissioner Geoffrey Starks

WASHINGTON, March 8, 2022 — Federal Communications Commissioner Geoffrey Starks said the agency’s Covid-19 Telehealth Program is helping American communities battle the pandemic.

“Even early in the pandemic, experts agreed that receiving care remotely could both meet many patients’ needs and help prevent community spread of the coronavirus,” Starks said at the FCC’s Connected Health Symposium Thursday. “Now, two years into this pandemic, the Commissioner said “we have ample evidence to show that telehealth made a difference in the national response to COVID-19.”

The FCC’s Telehealth Program was announced in April 2021 and has set aside $200 million for health institutions to continue to provide remote care for patients. The Connected Health Task Force is a working group within the FCC charged with gathering public and private stakeholders to accelerate the adoption of the latest health care technologies.

Americans have embraced telehealth since the onset of the pandemic. Researchers at the Urban Institute found that during the first six months of the pandemic, one-third of Americans have had a telehealth visit for health care.

Lower-income Americans have also sharply increased their use of telehealth services. According to the Center for Medicare and Medicaid Services, telehealth visits for Medicaid and children’s’ health insurance programs enrollment increased by more than 2,600 percent since 2019.

Starks also noted that as community behaviors change while communities lift restrictions, the McKinsey foundation found that telehealth levels have stabilized — to thirty times higher than before the pandemic.

Starks said communities have the opportunity to “leverage once-in-a-generation broadband legislation to expand access to high-quality health care” by enabling greater access to telehealth.

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