Telemedicine and e-Health

Intensive care unit telemedicine (ICU-TM) is expanding due to increasing demands for critical care, but impact on outcomes remains controversial. This study evaluated the association of ICU-TM and other clinical factors with 30-day, in-hospital mortality.

This retrospective, cohort study included 151,780 consecutive ICU patients admitted to nine hospitals in the Cleveland Clinic Health System from 2010 to 2020. Patients were identified from an institutional datamart and Acute Physiology and Chronic Health Evaluation IV (APACHE IV) registry. Primary outcome was 30-day in-hospital mortality. Analyses included multivariate logistic regression modeling, and survival analysis.

Overall, unadjusted 30-day, in-hospital mortality incidence was significantly different with (5.6%) or without ICU-TM (7.2%), and risk ratio was 0.78 (95% confidence interval [CI] 0.75–0.81) (p < 0.0001). Mortality rate for ICU-TM and no ICU-TM was 2.4/1,000 versus 3.2/1,000 patient days, respectively (p < 0.0001). Multivariate logistic regression showed that ICU-TM was associated with reduced 30-day mortality (odds ratio 0.78, 95% CI 0.72–0.83). Increased risk was seen with cardiac arrest admissions, males, acute stroke, weekend admission, emergency admission, race (non-white), sepsis, APACHE IV score, ICU length of stay (LOS), and the interaction term, emergency surgical admissions. Reduced risk was associated with hospital LOS, surgical admission, and the interaction terms (weekend admissions with ICU-TM and after-hour admissions with ICU-TM). The model c-statistic was 0.77. Median ICU and hospital lengths of stay were significantly reduced with ICU-TM, with no difference in 48-h mortality or 48-h mortality rate.

ICU telemedicine exposure appears to be one of several operational and clinical factors associated with reduced 30-day, in-hospital mortality.

To describe the epidemiology of patients accessing a pediatric urgent care telemedicine platform during the COVID-19 pandemic.

We conducted a cross-sectional study of the first 30,000 pediatric patients who accessed our pediatric urgent care telemedicine platform during the beginning of the COVID-19 pandemic. The study population came from 15 states and included the dates May 15 through September 16, 2020. We also described the groups of patients referred for in-person evaluation in urgent care or emergency department (ED) settings.

Mean patient age was 7.6 ± 5.4 years and 51% of patients were male. Twenty-one percent were publicly insured. More than 60% of patients sought care between 12 and 7 p.m. The most common reasons for seeking care were concerns for COVID-19 (50.5%) and fever (6.8%). Antibiotics were prescribed in 4.3% of visits. Children had an in-person visit to our urgent care offices on the same day in 9% of visits. Less than 1% of children were referred to the ED.

In this large series of telemedicine visits during the COVID-19 pandemic, fewer than 10% required escalation to an in-person office visit and fewer than 1% required escalation to an ED.

Prior studies have supported the effectiveness of blended interventions for anxiety and depression; however, outcomes research of large-scale blended interventions for these conditions is limited.

: To investigate the outcomes of scaled-up blended care (BC) cognitive behavioral therapy (CBT), a program that combined video-based psychotherapy with internet CBT, for symptoms of anxiety and depression.

: Participants were 6,738 U.S.-based adults with elevated symptoms of anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 8) and/or depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) at baseline who received BC-CBT as an employer-offered mental health benefit. The primary outcomes, anxiety (GAD-7) and depression (PHQ-9) symptoms, were routinely measured in the program. Recovery and reliable improvement in outcomes were calculated, and growth curve models evaluated change in outcomes during treatment and the effects of engaging in psychotherapy sessions on outcomes.

: On average, participants received treatment for 7.6 (standard deviation = 6.2) weeks. By the end of care, 5,491 (81.5%) participants had reliable improvement in either anxiety or depression symptoms; in addition, 5,535 (82.1%) fell below the clinical threshold for either anxiety or depression symptoms (i.e., recovered). Declines in anxiety and depression symptoms were statistically significant over the course of BC-CBT (both p's < 0.01), with the rate of decline significantly decreasing for each outcome as treatment progressed (both p's < 0.01). Each psychotherapy session completed was significantly associated with lower anxiety and depression symptoms during the week of the session and the subsequent week (all p's < 0.01).

: This real-world study provides evidence that scaled-up BC-CBT can be effective in the treatment of symptoms of anxiety and depression.

To examine the effects of coronavirus disease 2019 (COVID-19) on patients in an academic psychiatric ambulatory clinic, data from a measurement-based care (MBC) system were analyzed to evaluate impacts on psychiatric functioning in patients using telemedicine. Psychiatric functioning was evaluated for psychological distress (brief adjustment scale [BASE]-6), depression (patient health questionnaire [PHQ]-9), and anxiety (generalized anxiety disorder [GAD]-7), including initial alcohol (U.S. alcohol use disorders identification test) and substance use (drug abuse screening test-10) screening.

This observational study included MBC data collected from November 2019 to March 2021. Patient-Reported Outcome Measures (PROMs) were examined to determine changes in symptomatology over the course of treatment, as well as symptom changes resulting from the pandemic. Patients were included in analyses if they completed at least one PROM in the MBC system.

A total of 2,145 patients actively participated in the MBC system completing at least one PROM, with engagement ranging from 35.07% to 83.50% depending on demographic factors, where completion rates were significantly different for age, payor status, and diagnostic group. Average baseline scores for new patients varied for the GAD-7, PHQ-9, and BASE-6. Within-person improvements in mental health before and after the pandemic were statistically significant for anxiety, depression, and psychological adjustment.

MBC is a helpful tool in determining treatment progress for patients engaging in telemedicine. This study showed that patients who engaged in psychiatric services incorporating PROMs had improvements in mental health during the COVID-19 pandemic. Additional research is needed exploring whether PROMs might serve as a protective or facilitative factor for those with mental illness during a crisis when in-person visits are not possible.

The COVID-19 pandemic and the intervention measures have increased mental health problems among Americans. Telepsychiatry provides a safe and efficient way to serve mental health patients in emergency departments (EDs). The objective of this study is to evaluate the impact of COVID-19 on telepsychiatry consultations in North Carolina (NC) and analyze the differences across sex and race.

This longitudinal observational study used data from the NC Statewide Telepsychiatry Program to examine temporal changes in ED telepsychiatry consultations from January 2019 to March 2021 (117 weeks), including 4,739 telepsychiatry consultations conducted by 27 hospitals in 24 counties in NC during the period. The outcome measures were telepsychiatry consultation counts. Weekly ED telepsychiatry consultation counts were calculated overall and stratified by sex and race.

The overall weekly ED telepsychiatry consultation counts were decreasing before the national lockdown but started increase after the lockdown. Moreover, the counts of telepsychiatry consultations for white patients had a stronger increasing trend than that for black patients. Comparing telepsychiatry counts during the lockdown period (March and April) in 2020 and the same period in 2019, male patients had higher counts while female patients had lower counts, and white patients had higher counts while black patients had lower counts.

It seems that the COVID-19 crisis has led to a heightening demand for telepsychiatry consultations in NC, and there is a possible race disparity in these demands between black and white mental health patients. These findings underscore the need to further develop telepsychiatry services and enhance access to black patients.

Privacy concerns are a major barrier to online technology adoption. However, when consumers are facing personal risks (being ill) and environmental risks (pandemic), the effect of privacy concerns on continued use intention of telemedicine is unknown. The large user pool of virtual visits during COVID-19 provides a great opportunity to understand consumers' privacy concerns when facing personal and environmental risks.

This research investigates how patients weigh personal risks (e.g., illness) and environmental risks (e.g., pandemic) against privacy concerns when deciding whether to utilize telemedicine as an option for being treated for an acute illness.

Respondents (1,059 qualified) meeting the following criteria: ≥18 years old, U.S. residents, virtual patient for acute conditions during COVID-19, and a Human Intelligence Task approval rate of >95%, were recruited utilizing Amazon Mechanical Turk during the middle of the pandemic. An online survey was conducted to collect data.

Analysis indicates that first-time telepatients (82% of respondents) have greater privacy concerns than repeat users. Findings also indicate that patients who are female and have some college education or less reported greater privacy concerns. Interestingly, privacy concerns are positively related to continued use intention. This result holds when satisfaction and user characteristics are controlled.

When consumers are ill, privacy concerns still play an important role in telemedicine adoption. However, under environmental risks such as the COVID-19 pandemic, privacy concerns do not negatively impact their continued use intention, and satisfaction is positively associated with continued use intention.

Breastfeeding is an unquestionable right of mothers and their children; however, it is not a one-woman job. For breastfeeding to succeed, women must have access to appropriate support and guidance. The COVID-19 pandemic and subsequent restriction measures and lockdown to reduce community spread of the disease have negatively impacted breastfeeding support from health services and thus, in mothers' breastfeeding experiences.

The present study aims at evaluating the impact of the COVID-19 pandemic on breastfeeding consultations in LactApp (a mobile application [app] for m-Health focused on breastfeeding support, www.lactapp.com) during the COVID-19 pandemic.

We conducted an observational, descriptive, and retrospective study with LactApp data recorded between July 2018 and March 2021, including 9,151,456 queries classified in 48 topics among 137,327 active users. We used the Interrupted time series model to evaluate the increase of the number of queries consulted and active users due to the COVID-19 pandemic. Wilcoxon test was used to study the increase of certain topics due to the COVID-19 pandemic.

LactApp active users increased by 12,092 users (p < 0.001) during the COVID-19 outbreak and confinement and queries consulted in LactApp also significantly increased by 10,899 queries per month after the pandemic outbreak. The breastfeeding topics that significantly increased are those related to growth spurts, breastfeeding stages, breastfeeding technique, breast pain and mastitis, problems with infants not gaining weight correctly, hypogalactia, increased milk demand, and relactation. These findings are important to understand the potential of online tools when face-to-face professional support is unavailable.

Critical issues in breastfeeding establishment were highly consulted and significantly increased in the app during the pandemic. We believe that LactApp was a useful tool for breastfeeding support when women could not obtain appropriate support elsewhere. LactApp might be considered a powerful tool to identify critical issues of breastfeeding and trends in an automatized manner.

The use of direct to patient (DTP) telemedicine for common acute conditions is widespread. It provides certain advantages over in-person visits, but has led to concerns about fragmentation of care. It is unknown whether use of DTP telemedicine decreases use of primary care services in a way that leads to missed preventive screenings and immunizations.

Virtual urgent care (VUC) is a DTP telemedicine service to treat common acute conditions. All VUC encounters completed at an academic health system from July 2018 to December 2019 were evaluated and analyzed in 2020. Only patients established with primary care (at least one primary care visit in the same year as VUC encounter) were included. Specific preventive screenings (breast cancer, gonorrhea/chlamydia, and cervical cancer) and immunizations (tetanus and influenza) were characterized as up to date based on national guidelines. Chi-squares and multivariate logistic regressions were used to assess receipt of screenings and immunizations. Regressions included VUC and primary care utilization and demographic factors.

Patients evaluated (N = 1025) were mostly 25–50 years old (69.7%), women (81.8%), and white (74.9%). More than half (56.5%) had only used VUC once. In multivariate analyses, VUC utilization was not negatively associated with any of the preventive services evaluated, whereas primary care utilization was associated with receipt of both immunizations and gonorrhea/chlamydia screening.

Higher VUC utilization is not negatively associated with receipt of preventive services, as long as a primary care relationship is established. VUC may provide a useful method of encouraging receipt of preventive services, especially for younger patients.

Teleneonatology (TN) allows remote neonatologists to provide real-time audio-video telemedicine support to community hospitals when neonates require advanced resuscitation or critical care. Currently, there are no published economic evaluations of U.S. TN programs.

To evaluate the cost of TN from the perspective of the health care system.

We constructed a decision tree comparing TN to usual care for neonates born in hospitals without a neonatal intensive care unit (NICU) who require consultation. Our outcome of interest was total cost per patient, which included the incremental cost of a TN program, the cost of medical transport, and the cost of NICU or non-NICU hospitalization. We performed threshold sensitivity analyses where we varied each parameter to determine whether the base-case finding reverted.

For neonates requiring consultation after birth in a hospital without a NICU, TN was less costly ($16,878) than usual care ($28,047), representing a cost-savings of $11,168 per patient. Sensitivity analyses demonstrated that at least one of the following conditions would need to be met for TN to no longer be cost saving compared to usual care: transfer rate with usual care <12% (base-case = 82%), TN reducing the odds of transfer by <8% (base-case = 52%), or TN cost exceeding $12,989 per patient (base-case = $1,821 per patient).

Economic modeling from the health system perspective demonstrated that TN was cost saving compared to usual care for neonates requiring consultation following delivery in a non-NICU hospital. Understanding the cost savings associated with TN may influence organizational decisions regarding implementation, diffusion, and retention of these programs.

The general practitioners' increasing comprehensive pediatric health care provision in Austria faces great challenges in ensuring high-quality health care in the future as the shortage of pediatricians continues to grow. Tele-expertise services provide an excellent opportunity to facilitate and strengthen interdisciplinary collaboration and access medical expertise of uncertainties in diagnosis and treatment plans. The purpose of this study was to investigate and evaluate the usability, applicability, and clinical advantages of an Austrian tele-expertise platform for doctors, emphasizing its value to strengthen collaborative efforts to extend and ensure quality care in infant, child, and adolescent health while focusing on diagnostic acceleration, verification, and potential modification of a treatment plan.

A mixed-method approach included the retrospective evaluation of data provided via Intercom to elicit professional and geographical distribution and analysis of four hypotheses (H1: geographic distribution of initial enquires; H2: pediatric expertise level of the requester; H3: teleconsultations will result in changes in diagnosis and therapeutic decisions; and H4: teleconsultations stimulate cooperation and collaboration between physicians of all specialties). The study was based on survey questionnaires and qualitative semi-structured interviews.

Benefits were the most apparent in shorter diagnosis times, a potential quality increase in care, and cooperative stimulation. Intended therapy plans were found to be more sensitive to modification. Nevertheless, an overall positive attitude toward the teleconsultation chat became obvious. Moreover, the potential regarding quality improvements in pediatric primary care, shorter diagnosis time, and improved treatment options was found.

Outcomes are urging Austrian health authorities to establish political and legal structures for appropriate monetary compensation and broad application of an expert consultation system. The article further highlights the importance of teleconsultations in critical situations, such as pandemic times.

Suicide is one of the leading causes of death worldwide, and it can be prevented by psychotherapy. The objective of this study was to examine the risk factors predicting suicide ideation during messaging psychotherapy, and the moderating role of working alliance (WA) in the association between baseline depression and later suicide ideation.

A large outpatient sample (n = 4,388) engaged in daily messaging with licensed clinicians from a telemedicine provider. Using a longitudinal design, depression and anxiety symptoms were assessed at baseline, using the Patient Health Questionnaire (PHQ-8) for depression and the Generalized Anxiety Disorder (GAD-7) for anxiety. The WA was measured with the short version of the Working Alliance Inventory after 3 weeks of therapy, and suicide ideation was assessed at baseline and after 6 weeks of therapy, by item 9 of the Patient Health Questionnaire (PHQ-9). Demographic measures were also assessed.

Results indicate that depression (β = 0.09, p < 0.001), baseline suicide ideation (β = 0.50, p < 0.001), and WA (β = −0.08, p < 0.001), especially the task subscale (β = −0.14, p < 0.001), significantly predicted suicide ideation after 6 weeks. WA (β = −0.07, p < 0.001), especially the task (β = −0.14, p < 0.001) and bond subscales (β = 0.06, p = 0.002), moderated the association between depression at baseline and suicide ideation after 6 weeks, so that experiencing higher quality of WA decreased the association between depression and suicide ideation.

Suicide ideation may be reduced by experiencing the therapeutic relationship as beneficial, even among at-risk populations, which suffer from depressive symptoms. It is the first study to show this moderation effect in any platform of therapy.

Clinical trials evaluating facility-to-facility telemedicine may include sites that have limited research experience. For the trial to be successful, these sites must correctly perform research-related tasks. This study aimed to determine whether health care professionals at community hospitals could accurately identify simulated study eligible patients and submit data to a research coordinating center.

Twenty-seven community hospitals in the United States and Canada participated in this study. An electronic survey was sent to one designated health care professional at each site. The survey included a description of trial eligibility criteria and five written neonatal resuscitation scenarios. For each scenario, the participant determined whether the neonate was study eligible. One scenario required participants to submit 14 data elements to the coordinating center. Accuracy of study eligibility and data submission was summarized using standard descriptive statistics.

The survey response rate was 100% (27/27). Overall accuracy in determining study eligibility was 89% (120/135), and accuracy varied across the five scenarios (range 82–93%). Overall accuracy of data submission was 92% (310/336). Data were >95% accurate for 9 of the 14 data elements, with 100% accuracy achieved for 6 data elements. These results were used to clarify eligibility criteria, inform database design, and improve training materials for the subsequent clinical trial.

Health care professionals at community hospitals accurately determined trial eligibility and submitted study data based on written clinical scenarios. Research teams conducting telemedicine trials with community hospitals should consider completing pre-trial simulation activities to identify opportunities for improving trial processes and materials.

Autonomic dysfunction has been implicated as a consequence of traumatic brain injury (TBI). Heart rate variability (HRV) may be a viable measure of autonomic dysfunction that could enhance rehabilitative interventions for individuals with TBI. This pilot study sought to assess the feasibility and validity of using the Zeriscope™ platform system in a real-world clinical setting to measure HRV in active-duty service members with TBI who were participating in an intensive outpatient program.

Twenty-five service members with a history of mild, moderate, or severe TBI were recruited from a military treatment facility. A baseline assessment was conducted in the cardiology clinic where point validity data were obtained by comparing a 5-min recording of a standard 12-lead electrocardiogram (ECG) output against the Zeriscope platform data.

Compared with the ECG device, the Zeriscope device had a concordance coefficient (rc) of 0.16, falling below the standard deemed to represent acceptable accuracy in HR measurement (i.e., 0.80). Follow-up analyses excluding outliers did not significantly improve the concordance coefficient to an acceptable standard for the total participant sample. System Usability Survey responses showed that participants rated the Zeriscope system as easy to use and something that most people would learn to use quickly.

This study demonstrated promise in ambulatory HRV measurement in a representative military TBI sample. Future research should include further refinement of such ambulatory devices to meet the specifications required for use in a military active-duty TBI population.

Sudden transition to telerehabilitation during the coronavirus disease 2019 (COVID-19) pandemic was challenging for pediatric therapists, including physical therapists and occupational therapists, due to lack of prior experience and knowledge. The primary goal of the current study was to survey the pediatric therapists regarding the practice trends and specific challenges/strengths of delivering telerehabilitation during the pandemic.

An electronic survey was developed by the research term and validated through cognitive interviews with three pediatric therapists. A total of 107 therapists completed the survey. Descriptive statistics were used to summarize the trends for the survey questions.

The majority of therapists (92.5%) reported no prior experience with telerehabilitation. When comparing telerehabilitation with standard-of-care, the therapists reported similar session durations and frequencies, but greater caregiver-initiated cancellations of telerehabilitation sessions. Furthermore, a greater percentage of therapists modified the intervention activities compared with assessments, which impacted therapists' perceptions about quality of telerehabilitation as a greater percentage of therapists expressed confidence in treating children compared with assessing children virtually. One of the commonly reported telerehabilitation challenges was reduced virtual engagement of children, and strength was better assessment of home environment. Lastly, a greater percentage of therapists relied on consultations and fewer therapists used empirical evidence to guide their delivery of virtual care.

Telerehabilitation is a cost-effective health care model that offers remote accessibility and flexible scheduling. However, several limitations in the current pediatric telerehabilitation model, including lack of teleassessments and empirical evidence, could limit post-COVID use of telerehabilitation.

To describe referral patterns and attendance at follow-up visits for patients who received contraceptive counseling via telemedicine during the COVID-19 pandemic.

This is a prospective study of patients seen remotely during the early phase of the COVID-19 pandemic in New York City. We tracked referral rates, referral reasons, in-person visit show rates, and additional visits. We also administered a patient survey at 6 months. Using Stata SE 16, we conducted a multivariable modified Poisson regression with robust error variances to examine the predictors of attending an in-person visit within 30 days.

We included 169 patients who had visits between April 1 and June 30, 2020. Of these, 109 (64.5%) were referred for in-person visits, and 83 (76.1%) of those referred attended within 30 days. The most common reasons for referral were long-acting reversible contraception (LARC) removal and insertion. The relative risk (RR) of attending a visit within 30 days of referral was 24% higher for those referred for LARC removal compared with those referred for other reasons (RR 1.24, 95% confidence interval [CI] 1.08–1.69), and it was 29% lower for those aged 18–25 compared with those in the reference age (26–35) group (RR 0.71, 95% CI 0.51–0.98). At 6 months, 69.4% of patients were still using the method they decided on at the telemedicine visit, and 44.4% would choose telemedicine for their next contraception visit.

Approximately one third of patients seeking contraceptive counseling via telemedicine did not seek additional in-person visits over a 6-month period. Among the patients referred for in-person visits, referral reason and patient age may impact attendance rates.

Cost studies of telehealth (TH) and virtual visits are few and report mixed results of the economic impact of virtual care and TH. Largely missing from the literature are studies that identify the cost of delivering TH versus in-person care. The objective was to demonstrate a modified time-driven activity-based costing (TDABC) approach to compare weighted labor cost of an in-person pediatric clinic sick visit before COVID-19 to the same virtual and in-person sick-visit during COVID-19.

We examined visits before and during COVID-19 using: (1) recorded structured interviews with providers; (2) iterative workflow mapping; (3) electronic health records time stamps for validation; (4) standard cost weights for wages; and (5) clinic CPT billing code mix for complexity weighs. We examined the variability in estimated time using a decision tree model and Monte Carlo simulations.

Workflow charts were created for the clinic before COVID-19 and during COVID-19. Using TDABC and simulations for varying time, the weighted cost of clinic labor for sick visit before COVID-19 was $54.47 versus $51.55 during COVID-19.

The estimated mean labor cost for care during the pandemic has not changed from the pre-COVID period; however, this lack of a difference is largely because of the increased use of TH.

: Our TDABC approach is feasible to use under virtual working conditions; requires minimal provider time for execution; and generates detailed cost estimates that have “face validity” with providers and are relevant for economic evaluation.

The advance in digital media technologies has enabled the development of technologically mediated health care solutions. Mobile health app for mental health care is one of such innovative tools to monitor and manage users' mental health and psychological well-being.

This study examines the factors predicting the acceptance of mental health app (MHA) that are: technological (i.e., perceived ease of use and perceived usefulness) and sociocultural (i.e., perceived stigma toward mental health treatment and prior experience of face-to-face mental health service utilization).

Using structural equation modeling, we tested an extended Technology Acceptance Model with data from the Healthy Minds Study, a web-based national survey of U.S. college students (N = 429).

In addition to the technological factors, the sociocultural factors significantly influenced MHA acceptance. Notably, college students with higher levels of stigma toward mental health treatment were less likely to have experience of using face-to-face mental health service. This, in turn, led to more openness to accepting MHA that does not involve in-person visits but rather private and mediated communication.

Findings of this study provide critical insight into the increasing needs for and use of mobile apps for mental health care. Implications are discussed and future research directions are suggested.

Telehealth is increasing rapidly as a health care delivery platform, but we lack empirical evidence regarding how telehealth environments can affect patient experiences. The present research determined how physician's telehealth backgrounds affect various patient outcomes.

Participants viewed a 30-s video of a physician with one of six different virtual backgrounds and reported various socioemotional and cognitive responses to the mock telehealth experience.

Although the telehealth background manipulation did not impact participants' socioemotional or cognitive responses, participants' subjective perceptions of the telehealth backgrounds were related to important clinical outcomes, such as their ability to remember critical information from the appointment and overall satisfaction with the experience.

Telehealth environments may result in tradeoffs between patient experience, subjective impressions of clinicians, and information recall.

A physician's telehealth background can have measurable impact on patients' telehealth experiences, suggesting a need for careful background selection and design.

To assess the COVID-19 exposure risk to consulting ophthalmologists and the pandemic effect on consultations at one of the most impacted hospital systems in New York.

In a retrospective, cross-sectional study, ophthalmology consult notes and COVID-19 test results were collected from the electronic medical record from February to May in 2019 and 2020.

Of 2,215 total notes analyzed, consults decreased from 1,374 to 841 between years (p = 0.0002). In 2020, 22.5% of all consults were COVID tested and 2.4% were positive within 2 weeks of in-person evaluation. In 2020, 1.8% of consults were electronic. Ventilated patients increased between years (7.5% to 10.8%; p = 0.04).

Although consultations decreased during the Spring 2020 peak, the majority (98.2%) remained as in-person evaluations. While few patients tested COVID positive, this likely reflects the limited availability of testing early in the pandemic. Consulting ophthalmologists remained at high risk of COVID-19 exposure during the pandemic peak.