Ask an Expert: Coronavirus Hotline

How do you handle helping someone know whether they may have COVID-19?

A good example would be: We know that coronavirus causes cough. Well, what does that mean to someone that has asthma? It’s a matter of assessing whether that cough is different or more frequent or in some way not the same as the cough that they may have because of their asthma; or assessing whether they were at higher risk or lower risk. Deciding what recommendations would we give as far as home treatment versus at which point would there be a trigger to get with their provider? Discussing when would an emergency department be best.

What was the most difficult part of working the hotline?

I think people were very familiar with what the nurses on the front lines in the hospitals had to do, and physicians had to do, and respiratory therapists and grocery store workers had to do. I can’t thank all these people enough for all that they did and all that worked so hard.

However, there’s not a lot of people that really understand what the staff does here – that really get what it’s like to handle call after call, after call, after call, from people that are very distraught, distressed, unhappy, sometimes sick, and you don't have the answer that they need.

It’s very hard to do.

But all of my staff truly believe in the service and the need for it. So we’ll keep doing it as long as necessary.

Who works the hotline?

Because we have to do those individual assessments and you can’t train on every specific thing someone may ask, you’ve got to use a core group of people with knowledge of the disease to have that conversation.

That’s why all of our volunteers had to be in the healthcare field. So we used nurses and medics from the West Virginia National Guard and paramedics from the Kanawha County Ambulance Authority. We had some physician family practice residents here. We had some third- and fourth-year medical students here, some nursing students in their last few months of their training here – all supervised by our staff who have been practicing for quite a while.

All of that work was done onsite. We didn’t have our volunteers work remotely because you can’t do that continuous updating and training and supervising by walking around at a safe distance to hear what they’re saying and changing the focus of that conversation if you heard it not going the way it should. What we were able to do is spread our computers out into a larger area so that we could set the tables way far apart and extend our ethernet cables – we use the 100-feet ones – so that we can separate everybody around one common area with a lot of cleaning of surfaces to keep the people safe. But I think that was one of the keys: They needed to be together so that we could truly supervise what was going on and jump in and take calls when they were ringing off the hook.

What have the students working the hotline learned from the experience?

Most of the residents and medical students and nursing students that have come here have provided feedback that they learned a lot about what public health really means and how holistic it is. It’s not just discussing symptoms and a treatment and a test but trying to answer all of the variety of questions that people ask and discussing what their needs are related to a pandemic.

I think that was something that they hadn’t thought about before or had experience with.

We were very thankful for their help on the phone. Plus, they were appreciative, too, of having a rotation site when all of their rotations sites were closed, so they could meet their goals toward graduation and finishing up by July 1.

Which calls stood out to you?

We had an older woman call, and she was concerned that her symptoms were from the coronavirus and was very scared about going to an emergency department.

She was telling us about her signs and symptoms. But when you talked to her in-depth, a lot of the symptoms she had were in the days before she would have had any exposure so we started asking her about the presence of other medical conditions that she hadn’t relayed to us initially.

We found out that she had diabetes – uncontrolled diabetes. She had a lot of signs and symptoms, which led us to believe that it really wasn’t coronavirus causing her symptoms – though we never will say something’s not coronavirus over the phone. In talking to her, we were more concerned about complications from her diabetes and the serious nature of those at that time, and we were focused on really convincing her that going to the emergency room was something that she needed to do. So that’s one of those examples that sticks in my mind. 

On the one hand you have people that were not taking some of the guidelines seriously minimizing their degree of risk. On the other hand, we had some senior citizens that were completely the opposite and being overly cautious to the point of where there could be some significant decrease in quality of life because they were being very overly cautious.

We had one individual call who was even afraid to go down the street to use the mailbox to mail bills. We just spent time with her explaining how she could do that safely, and how it was still all right. Those prevention messages just weren’t about how to use disinfectants and keep six feet away. It was about how do you accomplish things that you need in your daily life and do it carefully.

We have a lot of people in West Virginia who don’t have access to the internet. They can’t afford it, or they’re in a dead zone and don’t have access to it, and they live in some of the rural communities that only get a newspaper once a week. They really want updates about what’s going on and to know the risks in their community. Therefore, we answered a lot of questions for people where we were their only source of updated information on what was going on with the coronavirus in their communities and in the state. In that population, we had a handful of people that would call us on a regular basis, which was fine because sometimes they’re shut in their homes, they couldn’t have visitors, their spouses might be hospitalized. We gave them the ability to just have a conversation with somebody for a few minutes every day. As I told my volunteers, that connection is an important health need as well. We were able to provide some extra time making sure we answered their questions and talked with them to ensure that they were still doing OK.

What were the first days like?

In the initial stages, we were taking over 400 calls a day. We had up to eight volunteers here, plus our staff. Then as the volume dropped after that first month, we cut back on those numbers. Initially we had multiple volunteers from 7 a.m. to 11 p.m. At night we can use our own staff here because we’re still open 24 hours.

The calls haven’t stopped yet, so we don’t have any plans at this time to turn the line off because that would also send a message that the coronavirus is over, and that’s not the case.

How is this different from other public health crises you’ve dealt with?

I’ve dealt with multiple public health disasters in my over 30 years of doing this. In some cases the call volumes were higher initially, but you kind of knew there was an end in sight.The most frequent crises I’ve worked on have been a variety of mass chemical spills. I worked in a state where a PCB [polychlorinated biphenyl] transformer exploded during rush hour. And all of the debris from that transformer went over a very large city – in New Orleans. PCB can be toxic with exposure. So that event only lasted a couple of days, but it was pretty intense for those two days. I’ve dealt with chemical explosions at chemical plants, overturned chemical trucks on the interstate in which multiple people driving through were then exposed, and chlorine leaks that affected entire communities. And the MCHM water crisis [in Charleston, W.Va.]. Those were all shorter-term events. So you just give up any other thing that you do and live at work for three weeks and get it done.

This current never knowing where it’s going to end is harder; we’re still trying to figure out the best way to keep going. I think that the worst was the first three weeks. And I think if it had stayed like that, I do not think that was really sustainable for the long haul.

How can everyone better prepare for public health crises?

I was looking back in my folder of the pan-influenza drills, and planning documents that were written shortly after the H1N1 pan-flu about 10 years ago. It’s been interesting to see everything we talked about and planned about come to fruition, but in looking at those, the idea that there would be a lockdown and severe social distancing was really not emphasized in those plans.

I think that really changed how we could mobilize for a pan influenza. What I hope happens is the response to this will help show people that planning has to be done by more than just people doing disaster planning. I know that everybody is busy. Physicians obviously are busy, healthcare providers are busy, businesses are really busy. But everyone needs to take the time out of their schedule to have planning sessions for what would we do if half our employees were ill and we still needed to operate? Everyone thinking: “Well, I’ll just close my practice because we’re small” doesn’t work when the community needs you. I’m hoping that people get the idea that somehow, some way, no matter what the business is, that planning and thinking about what your response is going to be for an epidemic needs to continue because everybody has to have a plan. It can’t just be the people doing disaster preparedness that are planning.

Now unlike 10 years ago, though, we have a lot more social media than we did during planning back then. Ten years ago, getting a website was a very complicated process and who knew if the people would use them? Being able to take advantage of social media to get messaging out has been really interesting to watch, both the good and the bad. You can get information out, but how does that change health messaging when you’ve got people blogging and tweeting and posting about information that may or may not be correct?

It makes answering questions a little bit more complex. And I think that we’ll have to put a lot more thought into public health safety messaging in this new era of social media as disaster planning moves forward.