• A New York hospital has repurposed a stroke survivor program to monitor people who are concerned about COVID-19 symptoms.
  • Detailed questions and technology allows doctors to remotely evaluate shortness of breath and cough and check for physical signs that may suggest the disease is getting worse.
  • Daily remote monitoring helps keep people safe and out of the emergency room.
  • You do not need to live in New York City to participate in the program, although doctors encourage you to seek care locally.

Video Transcript

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JOHN WHYTE: Hello I'm Dr. John Whyte, Chief Medical Officer at WebMD. And welcome to Coronavirus in Context. Today we're going to hear about an innovative way to help those patients who are concerned about symptoms that they might be having that they think could be coronavirus, but maybe they don't need to go to the emergency room. And we're going to find out what folks at Mount Sinai are doing.

And I'm delighted to be joined by Dr. David Putrino. He's Director of Innovation of Rehabilitation Medicine at Mount Sinai in New York. Dr. Putrino, thanks for joining me.

DAVID PUTRINO: Hey. It's nice to be here.

JOHN WHYTE: Tell me about this program. It's-- it's one-of-a-kind, isn't it?

DAVID PUTRINO: Yeah. So, um, it's a pretty novel remote patient monitoring program that we developed for, uh, people who COVID positive or COVID possible. Um, uh, and it was really responding to a need that we saw in the telehealth infrastructure that most hospitals were rolling out. And-- and the need that we really identified was the fact that, um, most telehealth strategies that were being developed to respond to this crisis were-- were centered around urgent care for individuals, um, so that, you know, we would have video visits with doctors, and-- and so on and so forth, but they really did not provide much in the way of daily follow-up to make sure that individuals were not, uh, worsening in terms of their COVID symptoms.

So we, uh, rapidly repurposed an existing program that we were using to monitor, uh, stroke survivors, and we, uh, focused a lot of what we were monitoring on respiratory symptoms, because these are the symptoms that are, you know, requiring escalation into the hospital system. And we started tracking patients on a daily basis. Um, what we've seen--

JOHN WHYTE: What do-- how does this work? What-- how-- how does it actually work? I'm a patient. I'm recovering, right? I'm not fully recovered, is that right? How-- how do you define who-- who's eligible?

DAVID PUTRINO: So really, uh, what we've been putting out there is anybody who is concerned about symptoms that are emerging. So, um, recovery is-- is probably not the-- quite the right-- the correct, uh, characterization. Um, it's anybody who has emergent symptoms that we-- that-- that are, um-- that they are concerned about--

JOHN WHYTE: Mhm.

DAVID PUTRINO: --um, can contact us via a text line, or they can contact us from the emergency department. Um, we-- we have physicians from the Mount Sinai emergency department who is-- who are, um, referring into our program. Uh, from there--

JOHN WHYTE: So they didn't need to be hospitalized or treated, is that-- they could just be concerned. Is that right? Is that what you're--

DAVID PUTRINO: That's correct. Yep. Yep. Anyone with symptoms who are concerned who-- who want to have daily monitoring, um, we're currently serving.

JOHN WHYTE: How do you measure symptoms of respiratory function of the lung remotely?

DAVID PUTRINO: yeah Really good question. So, um, we, uh-- you know, uh, we were somewhat fortunate in that we had some experience in monitoring, uh, respiratory status, uh, using subjective questions, um, uh, with research we had performed in the past in-- in, uh, uh, cystic fibrosis populations. Um, and so really what we're doing is we're-- we're asking certain, uh, questions about, uh, breathlessness, about presence or absence of a cough, about frequency of a cough, um, and whether the cough is productive or not. In addition, we're asking questions about, um, CO2 retention, so trying to understand is-- is someone having headache in the morning, because that's a good sign that they've been, um, retaining CO2 overnight.

We're looking into, uh, signs of cyanosis. So we're looking at, um, you know, are you noticing blueness around your lips. Um, and then in addition to that, we, uh, in individuals that we're particularly concerned about, we're, uh, sending them home with a, uh, pulse oximeter, or, uh, if they were not referred from our emergency room, um, process, we are shipping out pulse oximeters to them from the hospital, um, to really get a physiologic metric on how they're doing.

JOHN WHYTE: And what have you been finding so far?

DAVID PUTRINO: Well, so far, um, we've-- we've been having, um, a lot of success in keeping people out of the emergency departments.

JOHN WHYTE: Always good in this [INAUDIBLE].

DAVID PUTRINO: Always good, yeah. Um, one of the things that has been really striking for us is there is a lot of, uh, public anxiety about this condition, and so, um, we're seeing a lot of individuals who are developing shortness of breath, and, um, they're not-- they are not individuals who are necessarily used to having shortness of breath. It's a very new sensation to them. It's a very disturbing sensation to them.

And so their instinct is to, oh my god, I'm getting shortness of breath, I'm going to go straight to the emergency room. Um, and having a call with one of our providers is-- is really helpful for them because we can-- we can talk them through it, we can give them breathing exercises, uh, we can explain to them that we-- we've got their back, and we're monitoring them very, very closely, but, you know, having two out of four on a dyspnea scale does not necessarily mean you need to go to the emergency room. And in fact, if you do go there, chances are you're just going to be turned right around and sent back home after spending a couple hours in a crowded emergency room full of people who are COVID positive.

So, um, what we're really trying to do is keep people home, keep them safe, keep them calm. Um, we're-- we're seeing a lot of interesting data around, uh, just duration of the symptoms. Um, so our first data set that we froze showed that, uh-- showed that really symptoms, on average, are lasting for around 16 days, um, which, you know, is a really long course to be unwell for. And-- and I think people need to hear that. You know, some people are saying, oh my god, I've had a fever for 19 days, something is terribly wrong. That's really-- you know, that-- that's [INAUDIBLE] around to the spread of-- of-- of what we're seeing in-- in our cohort. And, um, yeah, this is a really long-- long-lasting condition.

JOHN WHYTE: Does this program work for everyone? Uh, are you allowed to have comorbidities? High blood pressure, diabetes, other things? Who's-- who's the typical patient for you?

DAVID PUTRINO: Yeah, you know, we've got such a range. We-- we, um-- we're really taking anyone who, um, who is concerned and wants to be monitored right now. Um, so we do have a number of individuals with-- with multiple comorbidities. Um, if we're particularly concerned about you, we'll track you twice a day, as opposed to once per day. Um, and what we're really trying to do is make sure that, uh, anyone who comes to us, uh, gets seen, and anyone who comes to us, um, feels safe and secure in the fact that they're being monitored.

JOHN WHYTE: Do you have to be in New York City to be able to be part of this program?

DAVID PUTRINO: Uh, actually no. We, um-- we have currently started, uh, taking on interstate, um, individuals if they-- you know, we're-- we're always encouraging individuals to try and reach out to their own services that are local because, of course, when someone is escalating rapidly, there's only so much we can do if they're living in North Carolina or in Florida.

Uh, you know, really at that point it's just one of our doctors saying, hey, call 9-1-1 and-- and-- and get an ambulance over. Um, so we do encourage people who are, um, interstate to-- to really try their absolute to-- to get similar services interstate, or at least, you know, contact their PCP and have a conversation over the phone. But, um, we aren't turning anybody away.

JOHN WHYTE: You think other institutions are going to soon be copying your lead?

DAVID PUTRINO: Oh, I hope so. We-- we-- in fact, on our website, we've put up detailed instructions on how to copy in great detail. This is a crisis. We want everyone to copy us. We want everyone to do what we're doing. Um, this is not about gaining patients or making money, this is about getting everyone seen in a crisis.

JOHN WHYTE: Tell us your website.

DAVID PUTRINO: Uh, the website is precisionrecovery.net. And there-- like I said, there's detailed instructions on how to do what we've done.

JOHN WHYTE: Thank you for joining us.

DAVID PUTRINO: No worries. Thank you.

JOHN WHYTE: And thank you for watching Coronavirus in Context. I'm Dr. John Whyte.