The Day the Earth Stood Still: COVID-19

We toyed with the idea of titling this editorial “Washington Finally Gets It—Telemedicine Works!” but chose to be a bit more Orwellian. In his 1940 science fiction short story, Farewell to the Master, Hiram Gilmore Bates, III, discusses an alien invasion of the Earth.¹ This short fiction was made into a movie in 1951 called The Day the Earth Stood Still² and was remade in 2008.³ The premise of the films is that an emissary (Klaatu) has come to Earth with his robot assistant (Gnut—Gort in the film), to warn the people of Earth of its coming destruction if they do not cease their behavior. Set in the depth of the Cold War and, in the later film, the abuse of the natural world, there are scenes in the films when the entire world stops. Nothing works, everything is at a standstill, and the entire population takes notice.

So, here we are in the middle of a global pandemic caused by COVID-19, a new coronavirus. The entire world appears to have stopped and taken notice. Well, sort of. World economies have come crashing down; whole industries have been sidelined or perhaps even shuttered. We can only get takeout food. We shelter in place and telework, and most importantly, people are dying. There is a growing demand for N95 respirator masks, ventilators, and testing kits. Is this the new normal? Doubtful, but the natural world has taken notice. Pollution has declined, the canals in Venice are as clear as swimming pool water, the air seems cleaner, and our health care is being pushed to its limits.

As we have said before in both our editorials and the content that is published in this journal, technology—specifically telemedicine—is one of the only ways forward. While we have seen amazing sacrifices by health-care workers and technologists developing rapid testing kits and vaccines, it is the integration and utilization of telemedicine and telehealth that has finally risen to the top. In many cases, telemedicine, telehealth, and/or e-visits were already in place in numerous U.S. states and were easily tapped to support patients quarantine in their domiciles and to alleviate the burden on emergency departments. Existing telemedicine systems can easily be tailored to address an unforeseen need. NASA’s spacebridge projects in the late 1980s and early 1990s demonstrated that.^4,5 Systems and protocols in place are much faster to respond than starting from scratch. Are there still naysayers out there?

Over the past several months, we have seen the emergence of telemedicine and telehealth as a key tool. President Trump said during a White House press briefing in March, “Medicare patients can now visit any doctor by phone or videoconference at no additional cost, including with commonly used services like FaceTime and Skype. A historic breakthrough — this has not been done before.” He further commented, “I tell you, what they’ve done with telehealth is incredible,” describing the technology as “a fairly new and incredible thing that’s happened in the not-so-distant past.”⁶ With the declaration of a national emergency under the Stafford Act and National Emergencies Act on March 13, 2020, the Trump administration is permitting telemedicine and telehealth to take place and be reimbursed. These two Acts were enacted in the past 50 years to give the President additional powers and authority to support the United States in times of emergencies. These two Acts have been used significantly over the past several decades. The telemedicine and telehealth part are unprecedented and may very well be the watershed moment for telemedicine and telehealth that we have been waiting for to become commonplace.

U.S. Department of Health and Human Service Secretary Alex Azar said, “Thanks to the Public Health Emergency I declared in January, more older Americans will be able to access healthcare they need from their home, without worrying about putting themselves or others at risk during the COVID-19 outbreak. Providers will be allowed to use everyday technologies to talk to telehealth patients, more telehealth services will be covered for millions more Medicare beneficiaries, and providers will be allowed to offer these telehealth benefits to Medicare beneficiaries at a lower cost than traditional services. From the beginning of the COVID-19 outbreak, President Trump has been knocking out every bureaucratic obstacle possible that stands in the way of a rapid and effective response. We are grateful to the hard work of those across HHS who put together these actions, and we’re grateful to American healthcare providers for working to take advantage of these options and continue their heroic work serving patients during the outbreak.”⁷

The American Telemedicine Association’s CEO, Ann Mond Johnson, commented, “We support Secretary Azar’s efforts to engage governors with a comprehensive strategy to rapidly expand access to telehealth during the COVID-19 pandemic. The ATA is working closely with our members to support states that have recently taken action to address barriers that prevent providers from delivering virtual care across state lines. We urge remaining states to work with HHS and other health care stakeholders to keep patients and providers safe and expand access to care during the COVID-19 outbreak.”⁸

We have become keenly aware of teleworking and social distancing. Well, telemedicine and telehealth empower these. If patients can be seen in their homes and their chronic disease can be managed remotely, why take the risk of going to the health-care provider’s office, clinic, or emergency room?⁹ There has already been an increase in manuscript submission to our journal and to other journals on this subject.^10–14

Clearly, the shackles of bureaucracy that have been holding telemedicine and telehealth back for decades has eased. So, our way forward must be measured, correct, efficient, add value, and so on. To do so in a hurry or by not thinking things through completely will only lead to further challenges, frustrations, and perhaps mistakes.

In the movie mentioned earlier, the world started back up but with keener awareness of our place on this Earth and what we can and cannot control. Perhaps moving forward beyond the pandemic, our education system, our way of working, and, most importantly, our way of managing our health will have fully embraced the concepts of telemedicine and telehealth. There is really no other way to address our growing health-care needs without these tools.

In the coming months, we will likely see a flurry of new submissions on telemedicine and telehealth and how they were used or are still being used in the pandemic and how it helped us all return from edge of the abyss.

Stay safe, practice social distancing, and enjoy the extra time you have with your families.