COVID-19 Twitter chat round up
On Friday 19 June 2020, Future Science Group hosted a Twitter chat on #TalkCOVID19. The COVID-19 pandemic has been dominating global news headlines and medical communities have been working tirelessly to combat the pandemic, and to ensure that other areas of clinical medicine are not detrimentally affected. In light of this, Future Science Group wanted to extend the conversation to a panel of experts to see their views on the changing healthcare environment. Michael Thompson (Aurora Health, WI, USA), Nikhil Sharma (University College London Queen Square Institute of Neurology, UK), Narjust Duma (University of Wisconsin Carbone Cancer Center, WI, USA), Boghuma Titanji (Emory University, GA, USA) and Jordan Strom (Beth Israel Deaconess Medical Center, MA, USA) made up the panel, bringing expertise from many areas in clinical medicine including infectious diseases, neurology, oncology and real-world evidence.
Below are the questions put to the panelists, and the discussion that ensued.
1. Please could you introduce yourselves?
The panelists each introduced themselves, their area of expertise and what they have recently been involved in working on.
A1). @boghuma – Boghuma Titanji, physician-scientist and Infectious Disease Fellow @EmoryDeptofMed . Happy to join as a panelist today. #TalkCOVID19
— BK Titanji #ILookLikeAScientist (@Boghuma) June 19, 2020
A1 – Thanks for having me. My name is Jordan Strom – I’m a noninvasive cardiologist (#EchoFirst and #whyCMR) and outcomes researcher @harvardmed @SmithBIDMC @BidmcCvi @BIDMC_CVImaging #TalkCOVID19 https://t.co/5bpXa9yl6G
— Jordan Strom, MD, MSc, FACC, FASE (@DocStrom) June 19, 2020
#TalkCOVID19 I’m Mike Thompson, MD, PhD, FASCO @mtmphd a Heme/Oncologist at @Aurora_Cancer in Milwaukee, WI. I specialize in Heme malignancies and oncology #PrecisionMedicine. Also work on #CCC19 @COVID19nCCC registry on steering committee https://t.co/Er7rS3UBOJ
— Mike Thompson, MD, PhD, FASCO (@mtmdphd) June 19, 2020
2. What have been some of the biggest changes to clinical practice and care provision within your specialty as a result of COVID-19?
The panelists are quick to highlight how healthcare systems all over the world, including the NHS in the UK, have done tremendously well to cope with the surge in cases and patients with COVID-19, but they note certain aspects have been unavoidably disrupted from having to weigh up the risk of COVID-19 exposure.
A2: We have seen massive disruptions to care, particularly acute care. #STEMI volume is significantly down and patients are presenting late to care. In many cases, people are afraid to seek care despite benefit of not waiting. #TalkCOVID19 https://t.co/y2dDFVTLtM
— Jordan Strom, MD, MSc, FACC, FASE (@DocStrom) June 19, 2020
#TalkCOVID19 A2: In oncology #COVIDnCancer I think it has been understanding the risk/benefit of continuing or delaying anti-cancer therapy vs the risk/benefit of #COVID19 exposure. Triaging early data to gain knowledge rather than hypotheses. #CCC19 https://t.co/L7LbIuG1zc
— Mike Thompson, MD, PhD, FASCO (@mtmdphd) June 19, 2020
A2: I will say the decrease in human connection, as an oncologist, connecting with my patients is an essential part. #TalkCOVID19 https://t.co/aglb5lLGbK
— Narjust Duma, M.D. (@NarjustDumaMD) June 19, 2020
3. What might we be able to learn from some of the challenges faced by healthcare systems so far during this pandemic?
We have seen that when there is a need for action, healthcare communities are learning to overcome challenges in innovative ways and hopefully this will inspire different ways of working in the future. Jordan Strom also points out that the pandemic has brought system disparities to light and challenges us to take heed of these issues and resolve them for a better standard of care in the future.
A3 That with teamwork, health care services can radically change overnight to meet challenges! #TalkCOVID19
It has also shown why clinics research is so important!! Very proud of @UCLIoN @LWENCCRF @UCLHresearch who have helped understand #Covid19 & neurological diseases https://t.co/fcibS2KXTc
— Dr Nik Sharma (@DrNikSharma) June 19, 2020
A3. Biggest lesson for me is #Telemedicine needs to be an integral part of providing healthcare. We shouldn’t need a pandemic to build that capacity. It has been a godsend to still be able to maintain some sense of continuity for patients using remote care tools. #TalkCOVID19 . https://t.co/gw48PhRrVo
— BK Titanji #ILookLikeAScientist (@Boghuma) June 19, 2020
4. How has use of telemedicine and digital health technologies within your specialty changed because of COVID-19?
The panelists show a general consensus that telemedicine can certainly play a role in each of their fields, but it certainly cannot completely replace some in-person aspects.
A4: The pandemic accelerated the implementation of telemedicine. It has changed our workflow, new patients are seen via telemedicine, we learned that many of our patients prefer telemedicine but also learned the effects of decreased human connection. #TalkCOVID19 https://t.co/NyGXaOswq8
— Narjust Duma, M.D. (@NarjustDumaMD) June 19, 2020
A4, 2: My hope is that insurance/payers continue to recognize the value in #telemedicine even after #COVID19 is no longer as acute of an issue. Certain things are best done in person however, and we need to find a good balance. #TalkCOVID19
— Jordan Strom, MD, MSc, FACC, FASE (@DocStrom) June 19, 2020
Mike Thompson makes a good point building on what Jordan Strom commented, saying that innovation in telemedicine could increase disparities in healthcare and this mustn’t be overlooked if telemedicine is going to be a permanent feature of future healthcare systems.
#TalkCOVID19 A4: #COVID19 has forced us to innovate & utilize technology bette (still not optimized). Telemedicine should be integrated into future healthcare, but needs reimbursement. Not every patient can or should use it & may increase #healthdisparities https://t.co/lJwWyRyN54
— Mike Thompson, MD, PhD, FASCO (@mtmdphd) June 19, 2020
5. What are some of the benefits and challenges associated with telehealth protocols within your specialty?
A5. Pro- option of not having to come in to the clinic, especially important for folks with transportation barriers, also fear of #COVID19 exposure clinic was a big issue for many patients at start of pandemic. Con-Some things are best assessed in person. #TalkCOVID19 https://t.co/Ji14ZHYJrK
— BK Titanji #ILookLikeAScientist (@Boghuma) June 19, 2020
A5: Challenges
Many patients do not have access to the internet, smartphones, or computers. It can be challenging when a language barrier is present. In addition, physician examination is still an important part of our care. #TalkCOVID19 https://t.co/ymXJQXmgqB— Narjust Duma, M.D. (@NarjustDumaMD) June 19, 2020
6. How can telehealth practices be optimized to ensure they are a valuable and lasting resource for protecting at-risk patient populations, whilst maintaining delivery of high-quality healthcare during – and beyond – the pandemic?
This question prompted some in-depth responses, highlighting very important issues such as access to telemedicine, adapting care based on individual patient characteristics, and logistical considerations including pay and medical insurance.
A6: Providing alternatives can help patients, phone over video for example. Ensure reimbursement by insurance and provide frequent appointments. #TalkCOVID19 https://t.co/js09ZOz7dA
— Narjust Duma, M.D. (@NarjustDumaMD) June 19, 2020
A6, 2: Second, we need to continue to advocate for equal payment for #telehealth visits so as not to force people to seek care in person if they could jeopardize their health by doing so. #TalkCOVID19
— Jordan Strom, MD, MSc, FACC, FASE (@DocStrom) June 19, 2020
A6, 3: Third, we should encourage new #telehealth technologies that are emerging and test them expeditiously so that we can understand their pluses and minuses. #TalkCOVID19
— Jordan Strom, MD, MSc, FACC, FASE (@DocStrom) June 19, 2020
7. Do you think we could see a sustained use of telemedicine in years to come?
The overarching opinion here was certainly a yes from the experts, but with caveats that it must be used appropriately for the setting.
A7. Telemedicine has grown on me. I still prefer seeing patients in person. I think nothing can replace that, but telehealth offers a valuable option to patients and should definitely stay on as part of the healthcare provider tool box. #TalkCOVID19 https://t.co/CMXSyatDsF
— BK Titanji #ILookLikeAScientist (@Boghuma) June 19, 2020
8. What impact has COVID-19 had on treatment regimens/use of certain medications/initiation of treatment rounds within your specialty?
In the scientific community many concerns have been voiced over the redirection of resources away from high-profile diseases in terms of treatment and research, such as in amyotrophic lateral sclerosis (as pointed out by Nik Sharma):
We need research in this area and the pandemic has set us back months and maybe years #TalkCOVID19
— Narjust Duma, M.D. (@NarjustDumaMD) June 19, 2020
9. How are you maintaining interdisciplinary communication between medical specialties during this time, to ensure fully informed and best treatment decisions are made?
Luckily, many tools have been made available to facilitate increased communication, with patient care at the forefront of clinician’s minds.
Q.9 lots of calls and emails. Fortunately I think everyone has been more attuned to the challenges of providing optimal care in a pandemic and kept on top of things in terms of making sure patients still get prompt interdisciplinary interventions as indicated. #TalkCOVID19 https://t.co/GJZQ7mf11l
— BK Titanji #ILookLikeAScientist (@Boghuma) June 19, 2020
A9, 2: As part of the #ACCImaging council, we have helped draft guidelines with the cardio-oncology group led by @mariellesc1 @CardioOnc_MR_CT and locally, our cardio-oncology group, led by @AartiAsnaniMD, has been very active in interdisciplinary rounds. #TalkCOVID19
— Jordan Strom, MD, MSc, FACC, FASE (@DocStrom) June 19, 2020
10. Is the focus on COVID-19 taking away crucial resources from other critical treatments? How could we tackle this?
We can see the impact of this across many different fields of medicine, with exposure being a large risk factor as well as from the patient’s side – delaying reaching out for treatment.
#TalkCOVID19 A10: Yes. Stopped screening. Stopped non-emergent procedures including biopsies. Stopped potential curative surgeries. Worry about hospital and ICU capacity to flatten the curve pushed off other care. We will take many months to catch up. #caprev https://t.co/p4gY3qNSDV
— Mike Thompson, MD, PhD, FASCO (@mtmdphd) June 19, 2020
A10: More than resources I think its delaying diagnosis in oncology. Many new patients were delayed or did not feel comfortable coming to the hospital and are now presenting with cancer at more advanced stages. #TalkCOVID19 https://t.co/tv2jG8TLMt
— Narjust Duma, M.D. (@NarjustDumaMD) June 19, 2020
11. What do you think the leaders of patient care organizations should be thinking about, and doing, right now?
Now this question was a real thought-provoker – there are a lot of big issues including racial disparities, mental health and the state of the economy that all need to be addressed, and only once this has happened can we hope to move on and progress in a sustainable way that leaves us more prepared for the future.
Correct, we can not forget the financial aspects of the pandemic. My fear is that small hospitals and practices in rural and low income areas will be closing and worsening access to care to our most vulnerable patients #TalkCOVID19
— Narjust Duma, M.D. (@NarjustDumaMD) June 19, 2020
A11. #Covid19 has cost so many lives across the globe. We must ensure that we put robust mechanisms in place to deal with any future pandemics. We also need to explore why #BAME populations have been disproportionately effected. #TalkCOVID19 https://t.co/22MFeyl219
— Dr Nik Sharma (@DrNikSharma) June 19, 2020
A11. Preparing for the long haul. #COVID19 will be around a while. Finding a balance so other aspects of health-care don’t suffer. Also, clear plans to support frontline healthcare workers, as threat of pandemic exhaustion and mental health effects are very real. #TalkCOVID19 https://t.co/ziXk1rdA1N
— BK Titanji #ILookLikeAScientist (@Boghuma) June 19, 2020
12. Do you think the COVID-19 outbreak will result in long-term changes to clinical practice, if so, how?
The final question in the Twitter chat gave a positive outlook, as the medical field hopes to learn and progress to improve standards of care, summed up nicely by Boghuma Titanji. The hope is that the support will be there so that we can prevent future outbreaks such as the COVID-19 pandemic.
A12. I hope there will be positive changes but these aren’t going to happen unless we all engage with politicians & funders to make them happen #TalkCOVID19
Again have the opportunity to correct the disparities that #BAME populations endure https://t.co/gZbcqZX53Y
— Dr Nik Sharma (@DrNikSharma) June 19, 2020
A12. Absolutely. I think we are all learning to do things differently and finding out some of the new ways are actually much better than what we had before the pandemic. This will lead to long lasting changes in how we provide healthcare.#TalkCOVID19 https://t.co/J6RG96MRWW
— BK Titanji #ILookLikeAScientist (@Boghuma) June 19, 2020
Thank you again to our panelists for spending their time with us for the #TalkCOVID19 Twitter chat, we had some challenging questions and even more challenging answers! It is really important to see different perspectives from all fields in medicine especially in open conservations on global platforms such as Twitter. Hopefully we will see some of the actions our panelists raised as we move forward from this pandemic.
Discover more content on the COVID-19 pandemic across our digital hubs:
Infectious Disease Hub – COVID-19: latest news and case numbers
Oncology Central – An oncologist’s perspective of COVID-19: “I wish I could hug you”
Neuro Central – COVID-19: the impact of the coronavirus pandemic on mental health and what we can all do
The Evidence Base – Social distancing and self-isolation 100 years after the 1918 influenza pandemic: what have we learnt from pandemics of the past?
The Nanomed Zone – Ray Owens on nanobody technology for use against SARS-CoV-2