In the days following his regular meeting on emerging infectious diseases in December 2020, William Chasanov began hearing chatter of a respiratory illness that “seemed to be different.”
“Well, it was scary,” he says. “They couldn’t really identify it. People were getting really sick, and it wasn’t from the traditional things that people get sick from.”
Chasanov, who specializes in internal medicine and infectious disease as the director of clinical transformation at Beebe Healthcare, began planning with his colleagues for the worst. Meanwhile, researchers isolated the virus’ genetic material, revealing it to be part of the familiar coronavirus family. Within weeks, nCoV-19, later renamed SARS-CoV-2, had touched down in the United States and altered history.
The COVID-19 pandemic continues to reshape the world, reconfiguring our economies, our governance and our daily lives. Perhaps nowhere are the shifts felt more acutely than in the healthcare industry.
While the virus was wreaking havoc globally, suffocating hospitals in Italy and in U.S. cities like Seattle, Delawareans got prepared. Local healthcare systems banded together with community centers, nonprofits, Gov. John Carney’s office, private businesses and each other to deliver care where it was needed.
ChristianaCare, the state’s largest health system, deepened relationships with places like the Latin American Community Center and Kingswood Community Center to provide testing and care for some of Wilmington’s most impoverished neighbors. At Bayhealth, clinical engineers worked in tandem with their counterparts at Bloom Energy to refurbish hundreds of ventilators.
For rural-serving systems like Beebe, the pandemic catalyzed a new approach to community health. They armed local libraries and a bookmobile with vaccines. In July 2021, Chasanov and other leaders unveiled the state’s first Hospital at Home program, which dispatches physicians and nurses to eligible patients’ homes to provide hospital-level care.
“When I look at kind of the delivery of healthcare moving forward, these huge leaps and bounds may not have happened as quickly if the pandemic did not occur,” Chasanov asserts.
By spring of 2020, Bayhealth and nearly every healthcare provider shifted nonemergency visits online. While telemedicine was already in use (for at least a decade in some cases, like at ChristianaCare), the pandemic accelerated its spread and scale.
During calendar year 2019, ChristianaCare performed a total of 1,667 virtual visits. From March 19 to December 31, 2020 (after the pandemic struck Delaware), that number rose to 182,956 virtual visits.
Thanks to innovators like Sarah Schenck, the medical director of virtualist medicine for ChristianaCare’s Center for Virtual Health, the local health giant was well ahead of the telemedicine curve. “Our vision has always been one of creating a digital health system, because we know that the future of healthcare is digital,” she says.
Schenck’s center launched a 100 percent virtual primary care practice in 2018, and the pandemic “accelerated our journey to digital health probably by two to four years, and we were able to bring up all of our ambulatory practices on telehealth, specifically video visits, in about three weeks back in March of 2020.”
To ensure ChristianaCare’s digital evolution didn’t leave Luddites behind, the company created a new workforce called Patient Digital Ambassador, a personal concierge of sorts who can guide a patient through any online scenario.
Uday Jani, a Milton-based integrative medicine practitioner, was another early digital adopter. Jani was dismayed by the volumes of misinformation and viral rumors he saw online—so he began recording short videos of himself and emailing them to his patients.
In the videos, Jani quells panic over vaccines, gives masking guidelines and even demonstrates at-home workouts. In one clip, he limbers up inside his office using a foam roller.
“My patients said, ‘Your video was good, but I like Jane Fonda better,’” he says.
Jani quickly realized he couldn’t reach all his patients online. He made house calls with vaccines for patients without smartphones or those with limitations like Parkinson’s disease.
And while telemedicine has its clear advantages, especially during an ever-changing pandemic, Jani is quick to point out its drawbacks.
“Telemedicine is very impersonal,” he says. “If the patient is present, he could remember three more things he wanted to ask you. If he’s on telemedicine, he will forget. A lot of things are missed in between.”
Live and in person, Jani contends, an observant doctor might recognize a dot on his patient’s skin as melanoma. “Now, with this telemedicine, the patient doesn’t even have to take his shirt off.”
Plus, the more we convert our everyday interactions into digital ones, Jani argues, the further we insulate ourselves from real human connections—potentially leading to depression and loneliness. “If you look at the data of loneliness, it can be as bad as smoking 15 cigarettes a day.”
The pandemic disproportionally impacted low-income and minority communities, widening the chasms that separate our affluent and our struggling working class. Economists now say COVID’s recession has become “K-shaped”: Those who held onto wealth and status before the pandemic are today thriving, while those who held low-wage jobs continue to face higher rates of unemployment.
These social inequities include access to health. Innovations like telehealth open a new door to access care but also lower a window on those without access to Wi-Fi or a device.
While inspiring partnerships and programmatic work have done wonders to serve high-need communities, the state’s poor and minority neighborhoods continue to be hit hardest by the pandemic.
As LeRoi Hicks, M.D., explains: “The underlying policies and outdated governmental structures that lead to income gaps are often the same that determine access to health care.”
Until we address the factors that contribute to differential outcomes in health, well-being and life expectancy based on race, ZIP code and income level, he says, “No technologic solution individually is going to result in a substantive change in closing the gap.”
“At the risk of inappropriately quoting John Donne, no man is an island. Without borders surrounding you—as you don’t have with a pandemic—community rates and transmissions go from one area to the next,” explains Hicks, the chief medical officer of Wilmington Hospital and leader of the Institute for Research on Equity and Community Health, or iREACH.
“It is in our best interest societally when it comes to infectious disease, and when it comes to things that initially are an epidemic proportions, and then reach pandemic proportions, to actually focus on pouring all of our resources into those communities that have the highest risk of disease transmission, even if it’s miles or hours away from you,” he says, “because that is really the only way to contain these things.”
While near-future health innovations like remote, real-time monitoring of a patient’s weight or glucose levels can help providers bridge gaps, health leaders agree that the future is digital. “Everything that can be done virtually will be done virtually,” says Schenck, “and home is the new venue for care.”