John Torous, MD (Digital Psychiatry, BIDMC) discusses how video consults offer an effective way to stay in close contact with mental-health professionals during the COVID-19 pandemic.

Wall Street Journal – November 14, 2020

How to Stay on Top of Your Health From Home During Covid-19

The Covid-19 pandemic has dealt a powerful punch to preventive care, delaying everything from cancer screenings to teeth cleaning. Even as doctors’ offices reopen, limited hours and social-distancing protocols can make it harder to get appointments. And with a surge in cases around the country, patients may still not feel comfortable with in-person visits and procedures.

The good news is that there are proactive steps patients can take to stay on top of health risks and concerns without leaving home. Virtual consultations are now being covered by public and private health plans. Home monitoring and testing devices can help manage chronic conditions—and determine whether there is a concern that requires an in-person visit. And depending on your personal risk factors, it may be fine to delay some screening tests.

Here’s a look at how and when preventive screening can be done safely at home, and some guidelines for when a visit to the doctor might still be the best practice.

Cancer screening

It is important to know your personal risk for different cancers, and to follow guidelines for screenings set out by the American Cancer Society and other medical groups.

For example, colonoscopies, which have dropped dramatically during the pandemic, are considered the gold standard for detecting colon cancer. David A. Greenwald, president of the American College of Gastroenterology and director of clinical gastroenterology and endoscopy at Mount Sinai Hospital in New York, says colonoscopies are “as safe now as always,” with new measures such as additional personal protective equipment for clinicians and pre-procedure Covid testing for patients. And following scheduling guidelines—for some, a colonoscopy every five years is advised—is especially important for those at higher risk due to family history or the presence of certain polyps in previous screenings.

For persons with average risk, and no symptoms, an at-home kit that enables users to collect stool samples for analysis by labs can be an option. Both the fecal-immunochemical test and the fecal-occult-blood test look for hidden blood in the stool, a sign of possible colon cancer, and should be repeated annually. Another home screening, the stool-DNA test, is typically repeated every three years and detects blood plus certain genetic variations in cancer cells that are shed in the stool. If any of these tests turns up positive, a colonoscopy must be performed, Dr. Greenwald says.

The American Cancer Society says women aged 55 and older who have had a normal mammogram within the past year could choose to have another as long as 24 months later. And while many women are screened for cervical cancer every year, if you have had only normal test results in the past, getting a test now is not urgent.

Skin care

Dermatologists are using more virtual video consults and shared digital photos to determine when something is worrisome enough for an in-person visit. Jules Lipoff, assistant professor of clinical dermatology at the University of Pennsylvania and chair of the American Academy of Dermatology’s teledermatology task force, says video consults can be ideal for helping patients manage acne and rashes such as eczema and psoriasis while avoiding in-person contact.

To screen for skin cancer, it isn’t necessary for someone without risk factors or symptoms to come in for a checkup. But an in-person visit is important for someone at higher risk, such as a patient with a history of melanoma, who is more likely to have recurrence or new malignancies. The academy’s website, AAD.org also has a guideline for patients on how to do a skin self-exam.

“If you see a new, dark, concerning mole, we need to see you and we need to do a biopsy,” says Dr. Lipoff.

Mental-health help

For those struggling with issues such as anxiety, depression and substance abuse, video consults offer an effective way to stay in close contact with mental-health professionals, says John Torous, director of the division of digital psychiatry at Beth Israel Deaconess Medical Center in Boston. Dr. Torous and his team offer face-to-face sessions over a videoconferencing platform and train patients to use a smartphone app called mindLAMP between appointments to take anxiety surveys, monitor their medication regimens and keep a mood journal.

Psychiatrists, social workers and other mental-health professionals use data collected through the mindLAMP app to gain better insight into the patient experience between sessions and to help customize treatment, such as assigning mindfulness exercises.

Despite some past reluctance on the part of clinicians and patients to use the technology, “ the pandemic forced everyone to start embracing telehealth, and realize these can be very efficient and impactful visits,” says Dr. Torous, who is also an assistant professor of psychiatry at Harvard Medical School.

At-home monitors

More devices and at-home-testing kits make it easier to self-manage certain diseases, such as high blood pressure and diabetes, and to share data securely with doctors to diagnose illness. Such tools are invaluable for patients unable or unwilling to come to the office, says Joseph Kvedar, president of the American Telemedicine Association and a professor of dermatology at Harvard Medical School.

“We can’t do everything by telehealth, but there are a whole bunch of things we can do,” says Dr. Kvedar. “It’s convenient and gives patients access to care they might not otherwise get.”

Among the new tools he cites are hand-held telehealth devices. One made by Tyto Care can listen to heart, abdomen and lung sounds, transmit heart rate and temperature, and look into the throat and ear canal. Tyto has partnerships with 150 health organizations in the U.S., allowing their clinicians to guide patients through remote exams. Consumers can also buy the device for $299 at Best Buy and connect to an online doctor or share data with their own physician.

Drugstores also now carry an array of home kits that test for cholesterol levels, urinary-tract infections, hepatitis A and B infections, thyroid function and prostate specific antigen, or PSA, levels, which can be elevated in the presence of prostate cancer. The kits use simple methods such as finger sticks for blood samples. Consumers should use such kits with caution as medical experts warn they aren’t a substitute for a doctor’s diagnosis.

Dental dilemmas

Covid has kept many people away from the dentist, where close contact and certain instruments such as drills and cleaning equipment can generate aerosols with the potential of spreading the virus. The American Dental Association says dentist offices have reopened with strengthened infection protocols and personal protective equipment for staff. They are using hand scaling rather than ultrasonic devices when cleaning teeth, high velocity suction when possible and protective rubber dental dams in patient mouths.

To maintain good dental health at home, brush and floss at least twice a day, as it can help prevent the buildup of plaque. Once plaque hardens into tartar, it can cause gum disease and tooth decay. Dental groups say tartar should only be removed by a professional, and advise against using home scaling kits. There are home repair kits in case of a lost filling or damaged cap, but they should be used as temporary measures until you are able to see a dentist.