How COVID-19 has pushed health care into the virtual world, helping patients get treated at home

Amid all the tragic news surrounding COVID-19 in Canada, the tens of thousands of cases and the thousands of deaths, the pandemic is also bringing about much needed change in the health-care system, according to one of the country's top doctors.

Dr. Barry Rubin, the medical director at Toronto's Peter Munk Cardiac Centre, says the novel coronavirus has forced clinicians to make virtual care a much bigger part of treating patients. In fact, he says, the pandemic has brought about changes in just a few weeks that have eluded health-care professionals for decades.

"We've talked about doing virtual care for my full time in health care, 25 years, but it's because of this pandemic that we're just forced to act," Rubin said.

Right now, at least half of the Peter Munk centre's patients are receiving virtual care through the phone, video chat or an app.

Rubin says all those patients being treated remotely will help hospitals manage the backlog of operations, now that the province is allowing elective surgeries to start again Tuesday. He says approximately 50,000 people in Ontario have been waiting for those operations.

"There's no doubt in my mind that the health-care system has changed forever," Rubin told CBC Toronto. 

"We're directly addressing hallway medicine," he said.

Rubin says virtual care has made patients feel safer, because they haven't had to enter hospitals that have been battling the pandemic. 

It's also helped save much-needed personal protective equipment (PPE), and created capacity for patients who need to be seen in person.

"The beauty of this system is … you get the exact same care that you would have received if you would have come to the hospital," he said.

It took just three weeks for two University Health Network (UHN) cardiologists to design an app specifically for COVID-19 patients to receive virtual care from home. 

Rubin says after just two weeks, 110 appointments were done and 53 follow-up hospital visits were avoided.

"I've never seen anything move so quickly in health care," Rubin said. "It shows you necessity is the mother of invention." 

UHN has also created virtual COVID-19 assessment rooms, which include a camera for the patient to video chat with the doctor or nurse on the other side of the wall. They can listen to the patient's heart and take a blood pressure reading without being in contact with the patient.

Rubin says he estimates at least half of clinical care appointments will eventually become virtual post-pandemic, and initial visits with doctors will be done over the phone or by video chat.

He says not only will it make physical distancing easier in waiting rooms, but maximize hospital resources.

'The hospital is the last place I would want to be right now'

Thanks to two pieces of technology and virtual care, Leorah Setton, 26, hasn't had to set foot in a hospital during the COVID-19 pandemic.

Last September, she was diagnosed with congestive heart failure and dilated cardiomyopathy — a disease that prevents the heart from pumping blood effectively.

When Setton first began receiving care at Peter Munk, she was in and out of the hospital a few times a week and her condition was poor. 

"I was throwing up, I was extremely nauseous," she said. "I had that pain in my abdomen again, my ankles were swollen. I was ticking all the boxes of the heart-failure symptoms."

In December, she had a device implanted in her pulmonary artery that continuously monitors for an onset of heart failure. Each night, Setton lies on a pillow that takes a reading and sends the information to the hospital. 

Her health is also monitored through an app called Medly, which was developed by UHN. It allows patients to input daily readings on their weight, blood pressure and symptoms, which is put into an algorithm and monitored by nurses and doctors.

"It's really like I'm having a hospital visit every single day but I don't have to leave the comfort of my home," Setton said.

"The hospital is the last place I would want to be right now."

Rubin says 550 patients are using Medly and 175 were added since the beginning of the pandemic.

He says the app allows one nurse to follow up to 350 patients at a time, compared to about 40 patients when check-ins were done over the phone.

Setton says she still gets symptoms every so often, but thanks to virtual care, her medical team is aware something is off before she tells them. She'll receive a call about the issue and instructions on how to remedy the symptoms.

She says it's allowed her to begin working nearly full time hours again and the stress of her health is no longer at the forefront of her life. 

"It's really changed my life back to almost what it was before," Setton said. "It  allows me to get back to what a normal 26-year-old old woman would be doing."

Virtual care addressing surgery backlog

As part of the first phase of Ontario's reopening plan, the province announced scheduled surgeries can gradually begin to restart Tuesday.

Since the pandemic started, Rubin says, operations were only done if patients would suffer irreversible damage or death within 14 days without surgery. He said about 25 per cent of surgeries were being done across the UHN, creating a "significant backlog."

Rubin says the hospital network is ready to begin ramping surgeries back up, but there are new protocols in place including testing each patient for COVID-19 prior to surgery.

Hospitals will ensure there is adequate staffing, PPE and capacity before performing surgery. He said virtual care is helping to address the backlog by freeing up those resources.

"There is a big ripple effect from that," he said

Rubin says surgeries may need to be performed during evenings and weekends, but added it's important to ensure staff aren't overworked.

With surgeries down at the Peter Munk centre, nurses have been redeployed to help in other areas including in long-term care homes. Nurse manager Dorina Baston says some staff are tired and the stress of the unknown is taking a toll.

"I think we'll be a little more vigilant for a while," she said. "I think we'll be a little tense and we'll have a heightened awareness and receptivity to what's happening around us." 

Baston says the pandemic has forced health-care staff to collaborate and communicate better, and that the shift to more virtual care doesn't mean the human component of health-care will be lost.

"In the end, we need it for compassion, for understanding, for support," she said.

"Feelings will never go away."