Questioning the Answers: What Covid-19 Data Is Showing

We are well into our fourth month of this pandemic. Looking at our graph (pictured below), purple shows influenza B peaking in December and influenza A peaking in February.

And, leaving aside an artefactual spike in mid-March, when we started co-testing for major respiratory viruses at the same time we started testing for Covid-19 in earnest, all other viruses have dissipated.

Then you see this impressive bump in Covid-19 illness, peaking in mid-April in our organization. Keep in mind, this is just positive tests for Covid-19 RNA in patients seen at UCHealth. Because we care for 1.9 million patients in Colorado, though, it is a reasonably large population sample. Furthermore, Covid-19 tests were scarce prior to mid-March, and numerous patients were likely developing Covid symptoms in February (see below).

So, how has this affected our visits and our telehealth efforts? Purple shows the dramatic dip with in-person outpatient visits, and the gradual climb back toward baseline. Then there is the green line of home telehealth video visits, going from nearly nothing to about 20,000 weekly in early to mid-March, with a gradual falling off in the past 8 weeks. It seems we might stabilize near 10,000 visits weekly; this is still about 100 times the volume of video visits prior to the pandemic.

Then there are the other trend lines that are interesting: Red is the ongoing volume of patient messages before and during the pandemic. Leaving aside the bump in mid-May (not sure why: perhaps related to a system-broadcast), our baseline of 22,000 messages per week increased to 30,000 — about a 33 percent bump in volume, starting to rise on Feb 22. This pre-dated by three weeks the steep decline of in-person visits and the upswing of telehealth visits on March 14, and the Colorado Stay at Home order of March 26.

Even more interesting: telephone volume (in blue) saw a tiny bump on March 14, but then was unchanged during the entire period. By contrast, in fuchsia, scheduled telephone visits (billable as of mid-March per CMS rules), appeared in early April.

In one graph, you can see online patient messaging demand scaling up, phone calls being static, and scheduled phone calls appearing when billable, on top of the change for in-person and video visits.

Some hidden factors at work here: UCHealth set up a Covid-19 nurse advice line; those calls are not visible on any line in this graph, and those hard-working nurses took tens of thousands of calls from Coloradoans (not just UCHealth patients).

And so, this data dilettante has to ask, could an increase in online patient messaging (regardless of content of message) be another possible leading indicator for future pandemic surges? We can’t be sure if these messages were about general anxiety, Covid symptoms, or perhaps completely unrelated, but it is suspicious that there is a sustained increase in volume of messages by 30 percent since mid-March. On the other hand, why isn’t online message volume falling, like home telehealth visits are falling, now that clinics are opening up in-person appointments? Stay tuned!

The open question now is: what will CMS do with paying for video visits and scheduled telephone visits? Will those payments stop or scale back? This will certainly affect all health systems still heavily relying on fee for service, until value-based care (insurance plans paying for quality instead of volume) takes over.

This piece was originally published on The Undiscovered Country, a blog written by CT Lin, MD, CMIO at University of Colorado Health and professor at University of Colorado School of Medicine. To follow him on Twitter, click here.