Health,Wellness & Telemedicine ‘blueprint’ for COVID-19 patients While Covid-19 patients who are unstable and in acute distress may need immediate in-person attention, many patients can be evaluated at home by telemedicine, thereby maintaining social distancing and reducing the spread of the disease. Limited guidance exists, however, for the remote delivery of healthcare, or “healing at a distance,” though the need has risen significantly during the pandemic. Now medical experts affiliated with NYU Long Island School of Medicine and NYU Langone Health have collaborated to develop a template for remote COVID-19 healthcare delivery, including protocols for assessing and triaging patients who may be COVID-positive. The spectrum of symptoms in persons infected with COVID-19 range from asymptomatic to severe and life-threatening; the more benign manifestations are often able to be managed from home. A new report, titled “A Telemedicine Approach to Covid-19 Assessment and Triage,” published on Sept. 10, in Medicina,
a peer-reviewed scientific and medical journal, outlines protocols for assessing various patient symptoms through virtual means. The paper notes that these protocols are most easily applicable in settings that have adequate internet or phone connections, and that, when the technology is available, telehealth is also promising for the delivery of care to persons living in remote areas where distance is a barrier to seeking help. “Most physicians have never before practiced telemedicine, and in this new world of a pandemic, our guidelines serve as a blueprint for safe and effective Covid-19 assessments,” said the report’s lead author, Allison B. Reiss, MD, Associate Professor in the Department of Medicine at NYU Long Island School of Medicine and head of the Inflammation Laboratory at NYU Winthrop Hospital’s Research Institute. A virtual assessment of Covid-19 symptoms is more feasible than one might imagine, according to the report’s
authors. A “Decision-tree diagram” in the report helps direct practitioners in classifying the seriousness of the infectious disease, while numerous adaptations to the physical exam can help detect symptoms. The telemedicine physical exam, for example, includes observing the patient’s breathing in order to detect “respiratory distress,” i.e. whether the patient is having trouble breathing, a warning sign of a more serious Covid-19 infection. Dr. Reiss noted that respiratory issues can be discerned virtually by “looking, listening, and counting” a patient’s respiratory rate and respiratory effort. A virtual viewing of the throat could be aided by a flashlight (a household member might assist). A patient exhibiting tenderness to the abdomen, upon their own touch, might indicate telltale Covid-related gastrointestinal issues, and so on. The report’s guidelines adhere to criteria established by the Centers for Disease Control (CDC), including for assessing the clinical stability of patients. “The rapid expansion of telemedicine
in response to the Covid-19 pandemic allows physicians to safely maintain connections to their patients in a way never before achieved—whether involving Covid-related or other medical issues,” said Eric Goldberg, MD, Senior Medical Director, Department of Medicine at NYU Langone Health and Clinical Associate Professor, NYU Grossman School of Medicine. “Telemedicine can also create deeper connections between a physician and patient, emanating from the personal spaces shared by each.” The collaborating institutions on the report were actively using telemedicine protocols prior to the onset of the Covid-19 pandemic but saw a rise in daily visits from 50 in early March 2020 to more than 7,000 by April 2020—completing more than 550,000 video visits during the March-August time period. The report authors say that, ultimately, widespread adoption of this technological tool will be determined by formal studies of quality, comparing telehealth versus in-person outcomes.
a blank slate media special section • september 25, 2020
07
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24 HEALTH, WELLNESS & BEAUTY • Blank Slate Media Newspapers, Friday, September 25, 2020
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Blank Slate Media Newspapers, Friday, September 25, 2020 • HEALTH, WELLNESS & BEAUTY
41
Despair can be deadlier than COVID BY J E FF R E Y L . REYNOLDS, PH.D Staying home and at least six feet away from others helps limit the spread of COVID-19 and saves lives, but a lack of social connection might paradoxically put people — especially those with preexisting mental health conditions and substance use disorders — at higher risk of death due to suicide, drug overdose, and alcohol poisoning. In January, the federal Centers for Disease Control and Prevention said that more Americans were dying from so-called “deaths of despair” than at any other point in history, and the last time we used words like “pandemic” and “crisis,” we were referring to widespread addiction to opioid painkillers and heroin. Now, six months into the COVID-19 crisis, the anxiety, depression and uncertainty that has plagued our nation, our communities, and our families continues to deepen and recent studies confirm what we are seeing among our family, friends, co-workers and maybe even ourselves. Federal researchers, for example, recently surveyed 5,412 Americans and found that more than 40 percent of respondents reported an adverse mental health or behavioral health condition, 13 percent said they had started or increased their use of drugs or alcohol to cope with stress or emotions related to COVID-19 and a whopping 25.5 percent of those ages 18-24 said they had “seriously considered” suicide in the last 30 days. In addition to young people whose college educations and entry into adulthood has been disrupted, racial and ethnic minorities, essential workers on the financial brink and caregivers for elderly adults appear to have been impacted the most. Moms with young children are also experiencing severe anxiety and debilitating depression at record levels and a recent Kaiser Family Foundation study found that 35 percent of moms said back-to-school stress and worry has had a “major” impact on their mental health. When asked for specific signs of stress, mothers were more likely than fathers to say they have experienced dif-
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during March and ficulty sleeping, April and remained poor appetite or high as we launched overeating, and online therapy sesfrequent headsions and groups. aches and stomSadly, overdoses ach aches. are also on the rise Anxious, with the Nassau overwhelmed County Police Deand desperate partment recently refor some relief, porting a 40 percent moms and dads increase in opioid alike are turning fatalities since this to alcohol and time last year. other drugs for Opioids like temporary comOxycontin, Percocet fort. and Vicodin alleviate Market rephysical pain, but search giant they also provide reNielson reported Jeffrey L. Reynolds, Ph.D lief for psychological in May that yearpain, as do alcohol over-year alcohol sales were up 27 percent and that online and other drugs. That relief, though, is alcohol sales via popular delivery apps temporary and within hours it returns, skyrocketed 300 percent between Febru- along with a hefty dose of guilt, regret and potential health risks. ary and April. So, what’s the key to getting through Sales of boxed wine increased tenfold during the first eight weeks of the the rest of 2020? Adequate sleep, proper nutrition COVID lockdown, while beer sales jumped 20 percent with the largest in- and daily exercise are key to maintaincreases in 24-packs. Sales of whiskey, ing good physical and mental health. vodka, gin and other spirits soared 23 Reaching out to friends and family, going for walks, practicing yoga, meditation percent. While drug use is harder to track and or mindfulness, playinggames or doing it will be months before annual govern- puzzles,can be helpful as well. Track ment surveys shed any light on drug use your alcohol and/or drug use. patterns, an analysis of more than 1 million drug-related comment threads on the popular Reddit chatboard suggests that Americans have also been turning to drugs to cope with the coronavirus pandemic, with sharp increases in conversations about marijuana, alcohol, hallucinogens, tobacco and cocaine. “The months of March, April, and May saw a remarkable rise in drug use, which leads to the conclusion that the pandemic has caused Americans to turn to drugs,” study authors wrote. “Drug use eased a little in July when the pandemic seemed to relax; however, when the second wave of COVID-19 hit us in July, Americans turned to drugs again.” Their observations mirror what we’ve seen in Nassau, where new admissions at FCA’s addiction treatment clinics in Hicksville and Hempstead climbed
Chart your stress levels, anxiety, depression and overall moods and take comfort in the fact that if you or someone you love needs help, there are counseling centers across Nassau County, as well as online resources that can provide support, guidance and care. Those things are the PPE (Personal Protective Equipment) that will keep us emotionally healthy, strong and safe as we await a COVID vaccine and a return to normalcy. Dr. Jeffrey L. Reynolds is the President/CEO of the Mineola-based Family and Children’s Association (FCA), which offers a variety of services, including mental services and addiction treatment. The organization can be reached at 516-7460350 or online at FCALI.org. h t t p s : / / w w w. c d c . g o v / m m w r / volumes/69/wr/mm6932a1.htm?s_ cid=mm6932a1_w https://www.kff.org/policy-watch/ its-back-to-school-amid-covid-19-andmothers-especially-are-feeling-thestrain/ https://www.nielsen.com/us/en/ insights/article/2020/rebalancing-thecovid-19-effect-on-alcohol-sales/ How COVID-19 Affects U.S Substance Use: What Reddit Data Tells Us
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