“The changes have affected everyone, and doctors are no exception,” Dr. James Giugliano said of his life the last several weeks.
As a board-certified family practitioner, who has been practicing in Southampton for over 30 years, his typical day once included face-to-face, hands-on, patient meetings from 8 AM to 6 PM, with minimal time spent answering phone calls and regularly working through lunch.
“Most days could start with hospital rounds, broken up by the occasional house call,” he said. But that has swiftly changed.
When COVID-19 first hit, Dr. Giugliano would see his regular patients out of two separate offices. It was business as usual, until the numbers began to rise. A few patients at a time dwindled to one, locking the doors in order to ensure precautions were adhered to. Things quickly progressed from there. Soon, patients with symptoms — cough, fever, etc. — “would be triaged by phone and made to wait in their car in the parking lot” for evaluation, so as not to risk the safety of others.
Early in the pandemic, before using a hazmat suit, he covered his arms and torso with trash can liners to avoid exposure, information discovered on a COVID-19 USA Physician Facebook account. It’s a group where over 143,000 international doctors share their experiences. Patients would then be instructed to come through a separate entrance at different times of day, causing the medical team to disinfect the entire area between each new visit as a means to minimize the spread.
Protocol changed rapidly and when the number of sick patients hit crisis levels. Dr. Giugliano was instructed to treat sick patients over the phone.
“The risk of contagiousness is perhaps the highest among the seemingly healthy asymptomatic and paucisymptomatic patients,” he said. “This makes it impossible to screen out contagious patients from entering your office and spreading it to the uninfected.”
Now all patients, even those deemed healthy, will be treated remotely as long as possible.
Fortunately, last year Dr. Giugliano learned about telemedicine, the practice of caring for patients remotely. At the time, a proper telemedicine visit required a privacy-approved site licensed by the Health Insurance Portability and Accountability Act. Six months before the COVID-19 pandemic hit, he was in the process of securing a site and, in a serendipitous twist of events, in early March it officially became available. But today’s new reality has allowed for a new lax in telemedicine regulation, as approved sites no longer require the HIPAA license.
“Just as people are avoiding risk of exposure by remaining home and are still productive in their jobs, so, too, are doctors conducting office hours every day with telemedicine,” he said.
With information changing on a daily basis, health care providers are on the frontlines of the facts, attending teleconferences and staying up to date with colleagues. Dr. Giugliano relies on the local organization Independent Physicians of Nassau and Suffolk, which is in cooperation with other New York programs. Due to the overcrowding and rapid spread of the novel coronavirus, the group aids patients discharged from hospitals in other areas, since, many times, those discharged haven’t fully recovered, but rather are sent home to clear beds for new admissions.
“The worse infections in the community are in hospitals and doctors’ offices,” he said, as many recovering remotely still need virtual care.
“It is safe to say all lives have been, or will be, touched by the COVID-19 pandemic,” Giugliano said, adding a member of his own family was diagnosed, and has since recovered. “This is not a drill . . . I would like to extend my personal admiration to thank all the health care workers; that include doctors, nurses, nurse practitioners, physician’s assistants, medical assistants, laboratory personnel, hospital housekeeping personnel, secretaries, etc. for all their knowledge and care in this crisis.”
Dr. Giugliano emphasizes to keep a small social bubble as “young people can be ‘super spreaders’” without ever appearing sick at all.