Diagnosed With COVID-19,Nope Just Cabin Fever: The Fundamentals of Staying at Home

In the fight against coronavirus disease-2019 (COVID-19), I have learned that sticking to fundamentals is essential for survival. A prime example of this is staying at home and washing your hands. Despite its simplicity and effectiveness and as I write this, there persists talk of taking a magic pill to cure all ails. Without proper scientific evidence to back this claim, I ask those of you considering this to please refrain from stockpiling hydroxychloroquine or overdosing on zinc.

As a practicing endocrinologist I, like countless other providers, have adapted many aspects of my life in order to continue providing care and support to my patients. Our abrupt shift to online care is not so foreign as the telehealth concept has existed since the 1800s in some form or fashion. However, the quick roll-out of telemedicine has not necessarily been in high-definition, but more Max Headroomesque. For our small endocrine department, the rapid implementation of telemedicine brings about zoom meeting after zoom meeting bordering on chaos. These meetings cover issues of reimbursement, charting requirements, Health Insurance Portability and Accountability Act (HIPAA) connectivity (most video modalities claim compliance, but hackers tested that with “zoombombing”), rescheduling of patients as televisits until (?) and data collection via diabetes software. Of these, it is the transfer of data that give us the biggest headache. Tidepool, Glooko, Clarity, Carelink, and Diasend are most of the web-based data software companies we use in clinic. Pressed to use new current procedural terminology (CPT) codes for remote monitoring of blood glucose (BG) meters, we find that the fundamental flaw with these platforms is not necessarily the software, but human nature. Of the myriad of issues, the most recurring are that patients will throw out or misplace the cable when getting the BG meter or if they have the cable are unable to download the software and upload the device. Due to these issues I have spend many hours in make-shift office in a corner of my bedroom talking patients through the setup of the telemedicine app or following them through their house in search of that elusive cable. It is in these conversations that I must also temper the need to divulge that patients with diabetes have a reportedly higher prevalence of complications from COVID-19, a higher likelihood of catching the virus, and represent over 50% of hospitalized patients with COVID-19. ¹ As there is no need to frighten those who are already frightened, I continue to redirect them to a more productive discussion touting the fundamentals of diabetes care.

Navigating through telephone and audio/visual visits (mostly telephone) in isloation, I am occasionally interrupted by my oldest daughter dropping in to show me a new toy or greeted with an occasional salutation of “thank you for your service.” Although I am not in the military and more so “riding the bench” in my bedroom office, I thank them and pass it on to my wife who is on the front line as a Hospitalist. I do, however, see their point as the risk has moved considerably to healthcare workers on the front line and even forcing dual healthcare families to live in isolation squared (my wife now lives alone in the basement). As the art of isolation management replaces the art of face to face contact I find myself expanding the term telemedicine for use as a verb, adjective, adverb, or even formal name. Verb: I just telemedicined three patients in 40 minutes. Adjective: Whoa, your virtual background is not very telemed. I suggest telemedding (Adverb) without the beach scene. Formal name: Telemed stop crashing and get back to work! To keep sane, I try to avoid the news and bury my head in telemedicine.

In conclusion, I predict that in the future the economic and psychological impact of COVID-19 will continue to reverberate into 2021, a vaccine may not be as effec-tive given the evasive nature of the virus, relief will truly come by November 3, 2020, grocery times on Amazon and Instacart will be available again in the summer and telemedicine will be a common practice in medicine (finally!). No matter what happens we must stay true to our craft. Instead of worrying about a 20 point difference in continuous glucose monitor vs finger stick blood glucose, we must think of the big picture, keep to the fundamentals, and try not forget why we became endocrinologists. I thank you for listening to my exercise in cabin fever therapy.