The novel coronavirus disease has and continues to present an overwhelming challenge giving rise to critical uncertainties in the delivery of healthcare services globally and across all sectors. The coronavirus disease has affected human mobility and peace, resulting in the confinement of masses in their homes and disrupting the routine care of non-COVID-19 patients. Between social distancing directives, stay-at-home orders, and event cancellations, COVID-19 has rendered society’s day-to-day operations nearly unrecognizable. The large-scale deployment of telemedicine by healthcare institutions has been regarded as one of the vital responses to the pandemic in the United States. The adoption of telemedicine by providers both nationally and globally achieves the objectives of (1) reducing the transmission of COVID-19 by protecting patients and providers from infection, (2) caring for infected patients during isolation and intensive care, and (3) continuing care for healthcare consumers and customary patients (Touil et al., 2020). Increased home care has also led to an increased interest in at-home sample collection and testing, both for convenience purposes and to steer clear of the potential exposure to SARS-CoV2, the virus that causes COVID-19.
Elements of the Problem
For the first time in history, the novel coronavirus has shut down the entire global economy, revealing how inseparable the economy and healthcare have become. In the past, healthcare has been immune to recessions (Touil et al., 2020). The demand for healthcare has been constant across the business cycle, whether people get sick during good and bad times (Touil et al., 2020). However, the recession brought by the novel coronavirus is different. Due to widespread public anxiety, social and physical distancing, self-quarantine, stay-at-home orders, and other restrictions imposed during the pandemic or out of fear of contagion, many patients with life-threatening medical illnesses or not, or acute medical conditions did not seek health care services (Khan, 2020) . COVID-19 resulted in providers limiting in-person visits to individuals with critical care needs that could not wait or be evaluated manually to limit unnecessary exposure and free up space in hospitals and medical offices. It is acceptable to state that patients, in consultation with their doctors, made informed decisions to postpone or avoid medical care at the onset of the pandemic.
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Patients in recovery programs for substance abuse and mental health problems may experience a relapse, as programs that occurred before COVID-19 may not be available due to lockdown and social distancing directives. Stay-at-home orders imposed by the federal government may contribute to individuals feeling isolated, leading to depression, anxiety, and mental health problems (Khan, 2020) . As people have been confined to their homes, their physical activity level is reduced, contributing to an increase in diagnosis and treatment of coronary heart disease, depression, high blood pressure, type 2 diabetes, and anxiety (Touil et al., 2020). Furthermore, there may be a concern for increased childhood and adulthood obesity as previous studies indicate that children and adults gain weight while leading a sedentary lifestyle. The pandemic has altered the delivery and access to healthcare globally and across the United States. Thus, healthcare systems are struggling with developing the right approach to engage patients across the spectrum and make them feel safe.
Analysis
While emergency departments across the United States are treating coronavirus patients, the number of patients seeking emergency care has decreased. Anecdotal evidence suggests that healthcare utilization decreased during the 2014 West Africa Ebola outbreak and the 2015 MERS-CoV outbreak (Middle Eastern Respiratory Syndrome) (Kuziemsky et al., 2020) . Data from the City of New York Fire Department found that they received an average of 69 cardiac calls daily, with about 39 percent resulting in death from March 20 to April 5, 2019 (Khan, 2020) . In 2020 during the same period, they experienced an average of 195 cardiac calls daily, with about 69 percent resulting in death. While deaths resulting from cardiac arrests may be attributed to undiagnosed and untreated COVID-19, it is possible that some may have occurred due to delays in seeking treatment for acute coronary syndromes (Touil et al., 2020).
During past pandemics, there has been a decrease in childhood immunization rates due to overstretched healthcare systems, breaks in the supply chain due to border restrictions, and parents not bringing their children to immunization appointments (Khan, 2020) . During the last Ebola outbreak, twice as many children died from measles than those that died from Ebola in the Democratic Republic of Congo (Touil et al., 2020). As a result, decreases in vaccination rates during the coronavirus pandemic could lead to outbreaks of preventable communicable diseases when lockdown and social distancing measures are lifted.
COVID-19 took the world by surprise and caught global healthcare systems off guard. The spread of the novel coronavirus caused high hospital overload, increased workload on healthcare professionals, and healthcare resources shortage (Khan, 2020) . The coronavirus pandemic had created indirect outcomes on healthcare providers due to deferred treatment of chronic illnesses and late interventions for time-dependent conditions (Bagot et al., 2018) . This issue is important to me because healthcare institutions during and after the curve should find solutions to meet the health care needs of the population and the need to restructure healthcare services and systems to meet the needs of a complex and changing environment.
Consideration Options
For any individual suffering from mild respiratory illness or exhibiting COVID-19 symptoms such as malaise, cough, or respiratory symptoms, isolation is required (Kuziemsky et al., 2020) . This means that the person must stay at home and receive home care. People who become sick and experience mild illness, home care is recommended as hospitalization may not be possible due to strained health care resources. Homecare is also considered when inpatient care is unsafe or unavailable. Patients presenting mild symptoms without underlying chronic conditions such as renal failure, lung or heart disease may be cared for at home.
Where appropriate, telehealth and telemedicine services to limit exposures to COVID-19, preserve personal protective equipment, provide care for patients with non-COVDI-19 symptoms, follow-up with patients after they have been released from hospital, and deliver advanced care planning and counseling to patients and family members in life-threatening situations or during a medical crisis (Bhatnagar et al., 2020) . Providers have embraced the use of telemedicine during the pandemic to eliminate unnecessary emergency department and patient visits. Prior to the pandemic, appropriately 60 major hospitals in the U.S. pre-existing telemedicine platforms. Attempts to mitigate the spread of COVID-19, the federal government revised healthcare policies to improve access to care, reduce transmission, and conduct coronavirus tests due to the stay-at-home restrictions.
The CARES Act granted patients access to care irrespective of their location and allowed other care services to be provided for reasons other than COVID-19. The Centers for Medicare and Medicaid Services authorized patients to have telemedicine visits with healthcare institutions with whom previously they had not established care.
Solution
Telemedicine is the combination of technology and devices that can remotely gain information on an individual’s health status and help determine whether there is a need or urgency to intervene. The coronavirus pandemic pushed healthcare systems globally to adopt digital technologies to keep patients, providers, and family interactions safe from the potential exposure to SARS-CoV2 (Bhatnagar et al., 2020) . With digital devices such as smartphones, tablets, and watches, providers can provide a high level of care in a timely and efficient manner without physically being present on site.
Telemedicine facilitates care provision in rural areas and hospitals, expediting care planning and eliminating unnecessary patient transfers to tertiary hospitals. Virtual consultations allow patients in rural areas to receive highly specialized care with contributes to improved population outcomes (Bhatnagar et al., 2020) . Telemedicine also makes it possible to utilize scarce healthcare resources that leads to improved patient outcomes.
By taking advantage of telemedicine, providers allow patients to access important healthcare services such as therapy, palliative care and consult with primary care practitioners over less severe diseases that may not require hospital visits for treatment (Bagot et al., 2018) . By eliminating or decreasing traffic in hospitals, providers are protecting employees and patients from unnecessary exposure. Providers are also deploying telemedicine for screening purposes to determine whether patients are needed for in-person visits (Bagot et al., 2018) . Screening helps eliminate duplicative hospital visits to different offices and establishing where the patient should be cared for.
Ethical Implications
Innovative technologies are influencing the way people perceive distance and time. Technology is also reshaping how people interact and relate with others, including when, how, and where patients and healthcare professionals interact (Kuziemsky et al., 2020) . Irrespective of the model of care, patients must trust providers to place their well-being above other concerns. Providers and physicians who engage in telemedicine have an ethical obligation to preserve the fiduciary responsibility of not disclosing any patient information and taking the necessary steps to eliminate conflicts of interest (Bagot et al., 2018) .
Physicians must acknowledge that the concern for patient privacy is legitimate. In telemedicine, patient information is available to different devices and physicians, increasing the risks of security breaches which may demean patients’ acceptance of telemedicine (Kuziemsky et al., 2020) . Providers and physicians must ensure that they implement the required protocols to protect patient information and gain their confidence in the adoption of telemedicine.
In the adoption of telemedicine, providers must understand that patients have different clinical needs, preferences, and situations and must not force the same solutions on them. What works well for one patient may not work well for another (Kuziemsky et al., 2020) . Some patients may prefer telemedicine, while others may not have a digital device to log on to. Such differences may increase the adoption of technology and exacerbate existing healthcare disparities (Kuziemsky et al., 2020) . Thus, patient-centered technology is not a one-size-fits-all, and the adoption of telemedicine must be case- and user-sensitive.
Adoption of Telemedicine
Compared with traditional healthcare delivery methods, telemedicine provides comparable population outcomes without compromising patient-physician relationships, and it has been shown to improve patient satisfaction and engagement (Bagot et al., 2018) . Telehealth can be adopted in every healthcare aspect, including virtual patient consultation with specialty services, bladder tracking with smartphone apps, remote provision of medically-induced abortion, postpartum blood pressure tracking with Wi-Fi-enabled devices, and fertility monitoring with patient-generated data (Bhatnagar et al., 2020) . Therefore, providers require a stable, secure, and resilient network, connectivity, and equipment. Physicians must ensure that they have the required hardware, software, and a secure internet connection to ensure patient safety and quality of care.
Conclusion
The pandemic has changed the delivery of care, and it will never be the same. Therefore, telemedicine strategies must always be updated to include potent care delivery strategies and interventions for all people. Virtual clinics have enabled timely access to care and human services despite the coronavirus pandemic.
References
Bagot, K., Moloczij, N., Barclay-Moss, K., Vu, M., Bladin, C., & Cadilhac, D. (2018). Sustainable implementation of innovative, technology-based health care practices: A qualitative case study from stroke telemedicine. Journal of Telemedicine and Telecare , 26 (1-2), 79-91. https://doi.org/10.1177/1357633x18792380
Bhatnagar, S., Biswas, S., Adhikari, S., Gupta, N., Garg, R., & Bharti, S. et al. (2020). Smartphone-based telemedicine service at palliative care unit during nationwide lockdown: Our initial experience at a tertiary care cancer hospital. Indian Journal of Palliative Care , 26 (5), 31. https://doi.org/10.4103/ijpc.ijpc_161_20
Khan, U. (2020). Telemedicine in the COVID-19 Era: A chance to make a better tomorrow. Pakistan Journal of Medical Sciences , 36 (6). https://doi.org/10.12669/pjms.36.6.3112.
Kuziemsky, C., Hunter, I., Gogia, S., lyenger, S., Kulatunga, G., & Rajput, V. et al. (2020). Ethics in Telehealth: Comparison between Guidelines and Practice-based Experience -the Case for Learning Health Systems. Yearbook of Medical Informatics , 29 (01), 044-050. https://doi.org/10.1055/s-0040-1701976
Touil, M., Bahatti, L., & Magri, A. (2020). Telemedicine application to reduce the spread of Covid-19. 2020 IEEE 2Nd International Conference on Electronics, Control, Optimization and Computer Science (ICECOCS) . https://doi.org/10.1109/icecocs50124.2020.9314459
