Last week I got my first glimpse of health care in the age of COVID-19.
Two days before Gov. Gavin Newsom ordered Californians to “shelter in place” — that is, to stay home — my teenage son Luis fell ill, with a sore throat, chills and fever, nausea and a pounding headache (but no cough or shortness of breath). By late that evening, his fever had climbed to 104.6 degrees and the advice nurse said to bring him to the ER immediately if it crept above 105 degrees. She asked about his weight and advised me to double the dose of ibuprofen I was giving him. Soon afterward, his pediatrician called from her home. Coughing throughout the call, she urged me to bring Luis in the next day if he still had a fever and sore throat. The clinic could not test him for COVID-19 — they had no test kits — but they could test for the flu and for strep throat. The clinic also offered telehealth consultations, but as she put it, “You can’t do a swab over the phone.”
The next day my son had a lower fever but he couldn’t shake his sore throat, chills and shaking, nausea and headache. My husband and I considered dragging Luis to the clinic, but he was wiped out from exhaustion. And if he didn’t already have COVID-19, plopping him in a waiting room could potentially put him at risk of infection. When an after-hours clinic with board-certified physicians in our network offered a telehealth consultation via Zoom, we jumped on it.
It turns out that providers can do some remarkable things over a screen. A young doctor materialized on our laptop and asked all of the right questions, then asked to take a look at my son’s throat. At this point the exam took on a slightly comedic aspect, with me as bumbling medical assistant. Balancing a cell phone flashlight in one hand and a laptop in the other, I practically shoved the webcam in my son’s mouth to give the doctor a good view. The flashlight lit up my son’s throat and bright red, super-sized tonsils: “Whoa, those are some really swollen tonsils!” he exclaimed. He went on to explain that the red and swollen tonsils could be a sign of strep throat, an infection that could also explain some of Luis’s other symptoms.
Given that hunch, he prescribed amoxicillin, an antibiotic that’s usually highly effective against strep. “I should be clear this is not a diagnosis, but my best educated guess,” he said kindly. “For a diagnosis, we’d need to do a swab.” He said it was still possible that Luis had the flu or even COVID-19 (!). “Be sure to get urgent medical care if he develops a cough or shortness of breath,” he advised. He wished my son goodbye, we all waved farewell, and the screen went black.
This is the rare case where strep throat was fantastic news. Thankfully, my son’s symptoms all faded within a day of getting the antibiotic. We were ecstatic. The telehealth exam — an attempt to provide medical care to as many people as possible without contributing to the spread of COVID-19 — was something new for the clinic, and there were some video quality issues and other kinks to work out. But all in all, the experience was a good one. In a time of relentless contagion, we were grateful to have that exam in the safety of our home.
Meanwhile, clinics throughout California and elsewhere are scrambling to offer telehealth consultations to minimize the risk of contagion. In this time of COVID-19, distance can be the best medicine.
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