I was the voice of social distancing, a proponent of mask-wearing from the very start. Still, after months of keeping distance from loved ones, the idea of a quick, safe, outdoor family gathering on a beautiful fall day, even if we weren’t going to be wearing masks, was too good to pass up.
A week later, I was sequestered in my bed, with a 103-degree-fever that didn’t break for 12 days, unrelenting migraines and aches, and what felt like an impossibly heavy weight on my chest, making breathing difficult and painful. There were three separate occasions during my fight with COVID-19 that I was encouraged to go to the hospital, but I refused. I was a nurse for 32 years, a Chief Nursing Officer at a medical software company, and I had a stash of medical equipment, most critically, a blood pressure cuff, a pulse oximeter, and a thermometer. In other words, I felt like I had the tools I needed to fight the battle at home.
Aside from all that, though, I was scared. I thought I would die if I went to the hospital. I was also petrified by the isolation promised there, with visitation suspended amid the pandemic.
So I stayed in bed, at home, where I could at least talk to my family, even if we were separated by walls or copious amounts of PPE. I laid prone; I bent over a hot bath to breath in the vapors. I did deep-breathing exercises, no matter how much it hurt to do so.
And I talked to my doctor. A lot.
Telehealth was the main reason I was able to stay out of the hospital. I talked to my doctor every day, through video chat, asynchronous messaging, or both. Before the pandemic, I thought telehealth was valuable in certain situations, but didn’t ever see it as a “change-the-world” technology. I think differently now. Thanks to those virtual interactions with my doctor, I was able to manage this devastating virus at home.
Telehealth, as valuable as it is, however, provides just one piece of the puzzle, especially when it comes to managing COVID-19 remotely. While engaged patients are better poised for success in any setting, it’s possible for a patient to remain somewhat passive in their own care in an inpatient setting, allowing doctors and nurses to take full ownership of care. The same can’t be said for at-home care with a condition like COVID-19.
I was taking my own vital signs constantly and keeping meticulous notes about my condition. Note taking wasn’t just a matter of preference – it was a necessity. Not only was the volume of symptoms dizzying, the fever and brain fog made it impossible to think clearly or remember on my own, for example, whether I had already taken a given medication. I wrote down what was happening each day and used that information to guide the telehealth interactions I had with my doctor. A daily journal emerged with vital signs, questions for my doctor, and notation of symptoms.
Having the tools at home to take my own vital signs significantly enhanced the effectiveness of my telehealth appointments, as I was able to provide up-to-the-minute oxygen saturation levels, heart rate, temperature and blood pressure. My doctor was able to take my report of symptoms and compare against my vital signs. My clinical background helped but the tools are user-friendly enough that with basic instruction initially can be used by the majority of patients.
As a longtime nurse, this was all familiar territory to me, but the disease still made it difficult and I had to rely on my family to help in many ways. They picked up prescriptions and administered them when needed. They advocated for me in ways they couldn’t have if I were in a hospital, especially without visitation. On the long road to recovery – months later, I’m still struggling with long-haul COVID symptoms like shortness of breath and persistent brain fog – they’re helping me stick to a care plan and remain active, informed participants in my recovery.
The battle with COVID-19 truly was, and continues to be, one of the most challenging ordeals of my life. And I literally fought that fight in the best conditions possible – with a medical background, an employer that was understanding and let me take the time I needed, a home that allowed me to stay distanced from my family, an attentive medical care team I could interact with virtually, and family members that had the time and the resources to help me when I needed it most.
So here’s my call to arms: When we look at the ravages of COVID-19 and its disproportionate effects on poor communities and communities of color, we need to keep in mind the critical role that social determinants of health play in this equation. As hospitals and ICUs increasingly reach capacity, telehealth and at-home care will become even more prevalent in treating COVID-19, but without the types of environmental factors – and devices – underpinning the success of my at-home care, patients, as well as their families, are bound to experience worsening outcomes.
We need to consider all the elements patients need to heal effectively: Do they have insurance? Are they financially secure enough to be able to stay out of work and recover? Do they have access to remote monitoring devices? Do they have access to food and prescriptions? Do they pose an exposure risk to other members of their family? Do they understand their care plan and do their family members feel empowered to help them?
As providers think about remote care, digital engagement needs to be a prerequisite. By proactively understanding patient environments, care providers can arm patients and their families with the information and resources they need both to heal as well as recognize and address gaps in care. An engaged patient is a partner in their own care, is treated with dignity and respect, and has a better chance for recovery.
About Lisa Romano, MSN, RN As CipherHealth’s Chief Nursing Officer, Lisa Romano, MSN, RN brings more than 25 years of experience in clinical practice, healthcare IT strategy, and healthcare operations to her current role. Prior to previous CNO roles, Lisa spent 19 years as a nurse and hospital administrator at Lehigh Valley Hospital and Health Network in Allentown, PA, where she was responsible for all patient flow and transfer center operations as well as numerous quality and patient satisfaction initiatives. Lisa is passionate about improving the health of patients across the healthcare continuum.