As the U.S. struggles to contain coronavirus infections, one of the lessons from China — where the disease originated and infection rates surged, but are now in decline — is to embrace digital healthcare.
The power of telemedicine is not so much creating a chatbot that can definitively diagnose the disease — the symptoms are too generic — but as a tool for providing healthcare virtually, allowing people to stay home and reduce the infection’s spread.
98point6 added coronavirus screening questions to their app in late January. The 5-year-old startup provides primary care nationwide, connecting to patients through an AI-powered chatbot and with doctors via texts and digital images.
On Monday, Portland-based Bright.md announced that it is providing a free, online coronavirus evaluation and screening tool to all U.S. hospitals. If a patient appears to be high risk of infection, the tool can notify healthcare providers.
“The COVID-19 scare will likely cause an overwhelming demand for hospital facilities and clinical resources, making it difficult to treat patients who need care the most,” said Dr. Ray Costantini, Bright.md CEO and co-founder.
Delivering care through digital channels keeps people who are contagious, though not seriously sick, at home and isolated. The approach also allows non-coronavirus patients to get the care they need, including renewed prescriptions or other services outside of a clinic or hospital where they might risk infection.
Dr. Bruce Aylward, the leader of a World Health Organization team that recently visited China, said that the country moved 50% of all medical care online, according to an interview with the New York Times. The Times reported that new coronavirus cases in China have dropped to about 200 a day, from more than 3,000 in early February.
As worries about the disease in the U.S. have increased, 98point6 has seen “large growth in enrollment and utilization,” said Younggren, who did not provide exact numbers.
Patients access the 98point6 app through employer-funded plans or they can buy a $20 annual subscription. When they log on, an automated response asks what brought them in. If patients report flu-like symptoms, they are connected with a 98point6 physician.
The doctors can provide answers to questions about coronavirus, more technically known as SARS-CoV-2, which can cause the illness COVID-19. The 98point6 screening can flag someone as having an increased risk of COVID-19 if they’ve traveled to at-risk areas or been in close contact with someone who has tested positive for the disease.
Without testing, providers can’t definitively tell if someone has coronavirus, even if they have the characteristic symptoms of a fever and dry cough.
“Our guidance is to have people go [or stay] home and do social distancing,” said Younggren, which basically means staying away from other people until a person feels better.
98point6 providers have continued revising the information and questions used for coronavirus screening in their app as well as their clinical guidelines to align with updates from the U.S. Centers for Disease Control and Prevention (CDC).
“We currently refer patients to state or local health officials if they meet the CDC’s definition of the level of risk that warrants testing,” Younggren said. “Testing is really a limited resource right now. If someone is really sick, we want to know, is this pneumonia, is this influenza, is this COVID?”
There is currently no specific treatment or vaccine for coronavirus.
Washington was the first state to report a coronavirus infection, and the first known U.S. coronavirus death occurred in Seattle on Feb. 26. Amazon reported this week that one of its Seattle-based employees tested positive for the virus, as did a Facebook contractor, prompting the temporary closure of a Seattle office. The current number of COVID-19 deaths in Washington is at 10, as of Wednesday, with one death reported in California.
In addition to his role at 98point6, Younggren is also medical director for emergency preparedness and an emergency physician at EvergreenHealth hospital. The main campus of EvergreenHealth, which is located in Kirkland, east of Seattle, has treated six of the patients who died of COVID-19.
Northwest companies including Microsoft, Amazon, Nordstrom, Facebook, Google, Rover, Tableau, Textio, Fred Hutchinson Cancer Research Center and others have encouraged employees to work from home if possible, and in some cases required them to do so.
Before the outbreak, 98point6 already had a contract with the Biomedical Advanced Research and Development Authority (BARDA), which like the CDC is a part of Health and Human Services, to share information about the rates and location of influenza and other respiratory illness gathered from patient inquiries. The data, which does not include identifying information about patients, could help healthcare providers struggling to understand and control the transmission of coronavirus.
“If we want to get a hold of this,” Younggren said, “we need to minimize the spread.”
Editor’s Note: This story was updated on March 9 with information about Bright.md’s coronavirus screening tool. It was previously updated clarify that the coronavirus screening was added to 98point6’s existing app, and to correct which agency includes BARDA.