Drive-in screening and a push toward on-screen appointments are among methods local family medical practices are leaning on as part of the effort to curb the spread of COVID-19.
From calling ahead for emergency appointments to remote examination rooms and even car-side service, doctors are looking for ways to provide six feet of separation between patients and keep waiting rooms healthier.
For the patients of Downtown Family Health Care, that means the waiting room could be the front seat of their vehicle.
The practice has been using the car waiting system since the flu season began. The idea is keep those who could have communicable diseases separate from others who are waiting to be seen for well care or chronic issues.
“About the worst thing you can do is to sit a healthy person next to a sick person,” said Dr. Greg Gelburd, of Downtown Family Health Care. “In the last few months, before COVID-19, we’ve been telling people to sit out in the car if they have flu symptoms and we’ll come out and screen them. Now that COVID-19 is a concern, we’ve strengthened that.”
Downtown Family Health Care has also set up separate examination rooms for those patients with fevers or may have had contact with a person diagnosed with COVID-19. From the initial assessment, patients may be tested either for strep throat, influenza or COVID-19.
“The initial assessment is most often done at the car and if it warrants additional testing, we can do that,” Gelburd said. “We have them come to the side door of our office where the nurses and physicians are masked and gowned and we’ll continue the assessment there.”
Fevers of 101 degrees and difficulty breathing are among the most common symptoms of COVID-19, according to a review of cases conducted by Harvard Medical School. For that reason, the practice asks patients with upper respiratory distress or fever to call when they arrive so that staff will know the patients are waiting in the car.
“The object is to isolate people who may be communicable from those who are healthy or have chronic conditions that may put them at risk,” Gelburd said. “We are encouraging our patients to come in if they feel they need to, but we’re taking more precautions than usual.”
The practice has set up a different phone number so patients can get the message quickly to staff.
“If someone has a fever and a sore throat or similar symptoms, we can do a strep test or a flu test so we can determine if that’s what we’re working with,” Gelburd said. “We can then do a COVID test, but we have a limited number of tests and there’s about a three-day turnaround.”
Gelburd said the practice is doing about five tests a day. He expects that number to increase as lab testing becomes more available.
So far, Charlottesville has one confirmed case of COVID-19, the disease caused by the novel coronavirus. Local health officials do not release how many area residents have been tested for the disease, citing patient privacy.
The national lack of tests compared to demand led Sentara Healthcare on Thursday to end after two days its drive-through testing program at corporate medical facilities in Virginia Beach, Williamsburg and Chesapeake.
“Because of our limited supplies, we must temporarily close all of our drive-through screening and testing locations,” the health system said in a statement. “We know that COVID-19 is a critical concern for our communities, so we are actively working with state and federal officials to get more testing supplies.”
The test shortage has led many practices and facilities to increase use of telemedicine, allowing patients to talk with physicians via Skype, Facetime or other online video chat applications.
“You can’t do a physical examination, but as long as we have face-to-face contact we can work with patients via telephone for those who need to stay at home,” Gelburd said.
Telemedicine recently received a big boost from the federal government. On Tuesday, Medicare officials expanded coverage for telemedicine nationwide to help those with health problems stay home in the hopes of avoiding the novel coronavirus.
The option allows patients to take care of ongoing medical problems and new concerns while heeding public health advice to stay home during the outbreak.
According to the The Associated Press, current telehealth coverage under traditional Medicare is limited. Payments are made only to doctors serving rural areas and specially-designated sites to which patients must travel to see a doctor by internet.
Tuesday’s announcement means clinicians and hospitals may bill Medicare for telemedicine visits that do not take place in person, at a medical office or facility.
The rule is part of Medicare changes approved by Congress under emergency declarations from President Donald Trump. Expanded telemedicine coverage will remain in effect during the outbreak.
The method has long been used by university medical systems, including the University of Virginia Medical Center’s Karen S. Rheuban Center for Telehealth.
The program, which provides doctors and patients with general check-ins as well as training for specialized conditions, began more than 20 years ago and serves patients outside of the area and across the state as a way for patients to make appointments without taking time off of work or incurring travel expenses.
Albemarle County primary care provider WholeHealth Medical is also utilizing telemedicine to help screen for possible flu and COVID-19 cases.
“At this time we are encouraging that all patients consider taking advantage of our virtual visit capabilities for all visits including sick visits, wellness visits and medication checks,” the practice’s website states. “If bloodwork or vaccines are needed, then we can schedule appropriately to try to reduce your risk of exposure to ill patients.”
Gelburd said he believes the current pandemic could prove the efficacy of telemedicine.
“It’s something that’s been done for a while but has had a lot of restrictions in place,” he said. “I think, at the end of this crisis, it will be more accepted and it could be a big benefit to everyone.”