How The Pandemic Changed Health Care in Cleveland

The COVID-19 pandemic has transformed many aspects of everyday life, and health care has arguably experienced some of the greatest changes.

Charlene Mallory, a Hudson resident, recently called for a doctor’s appointment for the first time since before the pandemic after experiencing headaches and fatigue for a couple of weeks. But when she called her doctor’s office, she got some surprising instructions – she needed to test negative for COVID-19 before she could be seen in person.

“There was enough overlap with the COVID checklist … that they would not even consider seeing me until I got a COVID test,” Mallory said.

Mallory goes to a regional University Hospitals facility, which arranged for her to get a test through the UH system. While the process was easy, she was concerned that this would delay her even more from getting her symptoms checked out.

“If that test comes back positive for some reason, I might not be able to see somebody for the symptoms I called them about for a few weeks,” she said.

“I believe they make you wait until you test negative again for the active virus before they give you the all-clear … that concerns me a little bit," Mallory said.

Hudson resident Charlene Mallory recently saw her UH primary care physician and had to pass a COVID-19 test before she could be seen in-person. [Charlene Mallory]

Mallory did end up testing negative and got in to see her doctor the following week.

According to UH’s visitor policy, patients are evaluated on a case-by-case basis on whether they should be seen in person or be referred for a COVID-19 test depending on their symptoms.

Mallory's experience is just one example of changes in the Cleveland area health care system that may last for while, even as the number of coronavirus cases appears to be trending down locally and in Ohio.

Other changes are strikingly apparent in the lobby of the Cleveland Clinic’s Sydell and Arnold Miller Family Pavilion on any given weekday.

While the building is home to many of the hospital’s departments including its urology and vascular institutes, the number of people visiting the building has significantly dropped since March 2020 – before COVID-19 restrictions hit.

Back then, the building was usually bustling with patients and their visitors, as well as vendors and community members using the space for meetings.

“Anyone could come and go,” said Alicia Reale-Cooney, communications specialist at Cleveland Clinic.

Now, the place is at its busiest around 11 a.m. – when inpatient visitor hours begin. Masked individuals wanting to visit their loved ones wait in a line stretching from the entrance on Euclid Avenue to the lobby checkpoint, which consists of a temperature reading and health screening.

At the lobby checkpoint in the Miller Pavilion, visitors are escorted to health screening stations before they are permitted into the building. [Anna Huntsman / ideastream]

All Northeast Ohio hospitals implemented restrictions and safety measures like these when COVID-19 was first starting to spread in the area.

In fact, MetroHealth, Cleveland’s West Side hospital, initially prohibited visitors and converted all doctors’ appointments to virtual when the first COVID-19 cases were reported in the state.

“For a few weeks there, we were only doing care delivery over the phone and video,” said Dr. David Margolius, director of internal medicine and primary care physician at MetroHealth.

“Now, we’ve settled out to a place where we’re doing about half of our visits through telehealth, which is mostly over the phone," Dr. Margolius said.

It took some time for doctors and patients to get used to the new model of care, but after working out the kinks, the response has been mostly positive, he said.

It especially works well for many patients who might not have the means to make it to every appointment, Margolius said.

“Our no-show rate has almost disappeared with telehealth visits, whereas prior to, when we were only dependent on in-person visits for that type of care, our no-show rate might be 20 to 30 percent in some of our poorer neighborhoods,” he said.

“Now, that's gone on down to zero to 10 percent for telehealth," Margolius said.

Albert Ferreira, director of telehealth operations at MetroHealth, agrees, touting the hospital’s new streamlined process for deciding whether a patient’s visit should be held virtually or in-person.

“We have developed, kind of, a questionnaire and triaged process to be able to try to screen those out as best we can,” Ferreira said.

“Ultimately, if a patient is given all the options and they prefer an in-person visit, they're given that they always get to choose which option they prefer,” he said.

Caregivers are now equipped with proper personal protective equipment, and safety precautions have been implemented so that patients can come in even if they are feeling sick, Margolius added.

However, some doctors may have even been overtreating patients before the pandemic, he said.

“If you're coming in the first five to seven days with those symptoms and you’re otherwise relatively healthy, I mean, it's a virus, nothing's going to change for the most part based on my exam,” Margolius said.

“The treatment is, you know, reassurance and over-the-counter symptomatic relief and that sort of thing … I could have done all that over the phone," he said.

There are some cases where the patient needs to be physically seen so that doctors can record their symptoms and run tests, he added.

Patients will always see doctors in person for some specific issues, but telehealth is here to stay – and doctors are learning new ways to expand it even further in the future, said Steven Shook, who leads the virtual health program at Cleveland Clinic.

Eventually, doctors may even be able to remotely monitor patients with chronic health issues, he said.

“These things that are very data-heavy - like blood pressure and diabetes, which are glucose levels, COPD or heart failure - some of the metrics that we use to judge how patients are performing or doing those diseases, those lend themselves very well to digital or health care model,” he said.

Visitors head into the Cleveland Clinic's Miller Pavilion just before visitor hours begin on March 11, 2021. [Anna Huntsman / ideastream]

The Cleveland Clinic went from 37,000 virtual visits in 2019 to 1.2 million in 2020, Shook added.

Shook and other Cleveland hospital officials add that these visitor restrictions and checkpoints are also here to stay while the community spread of COVID-19 is still high here in Northeast Ohio.

But as more people are getting vaccinated and other health orders are lifted, the day may come soon when the hospital lobbies are once again bustling with sounds of patients, visitors, vendors, and community members.