Telehealth Surged as COVID-19 Arrived: U.S. Visits, January–March 2020

In February 2020 CDC advised people and health care providers in areas affected by COVID-19 to practice social distancing, and urged health care facilities to offer care virtually, through telehealth — the use of two-way telecommunications to deliver clinical care remotely. To see what happened next, CDC analyzed de-identified visit data from four of the largest U.S. telehealth providers, which serve all states, comparing January–March 2020 with the same weeks of 2019.

A sudden rise

About 2.7 million visit records were analyzed.

• In the first three months of 2020 there were about 1,629,000 telehealth visits, against 1,084,000 in the same period of 2019 — an increase of 50%.
• In the last week of March 2020, visits were up 154% on the same week a year earlier.
• Over the same late-March weeks, emergency department visits fell sharply compared with 2019, according to CDC’s National Syndromic Surveillance Program.

Weekly telehealth visits, 2019 and 2020, with the change in telehealth and emergency department visits. Image from CDC’s page.

Who used it, and why

Most telehealth patients were adults aged 18–49 (66% in 2019, 69% in 2020) and women (63% in both years); the 18–49 share rose from 68% in the first week of January 2020 to 73% in the last week of March. Children made up a slightly smaller share than in 2019: 3.5% of visits were for children under 5 (4.0% in 2019) and 8.6% for ages 5–17 (10.0% in 2019).

Most patients — 93% — sought care for something other than COVID-19. But in the last three weeks of March, COVID-19-related visits climbed from 5.5% to 16.2% of the total, as more patients mentioned COVID-19 as their reason for the visit. Visits were counted as COVID-19-related if they involved fever plus cough, sore throat or shortness of breath; a diagnosis code for COVID-19 or suspected exposure; or the words “COVID” or “coronavirus.”

Suspected COVID-19-related telehealth visits by week, early 2020. Image from CDC’s page.

What happened after the visit

In 2020, 69% of telehealth patients were managed at home, 26% were advised to follow up with their primary care provider if needed, 3% were referred to urgent care, and just 1.5% were told to go to an emergency department. These patterns barely changed as the pandemic arrived.

Why the surge

Several changes may have driven it:

• Federal policy. On March 6, 2020, the Centers for Medicare & Medicaid Services issued emergency (“1135”) waivers, and the CARES Act took effect March 27. Together they improved payment for telehealth, let providers see patients in other states, allowed more kinds of providers to offer it, reduced or waived patients’ cost-sharing, let federally qualified health centers and rural health clinics offer it, and allowed virtual visits from patients’ homes.
• Avoided care. Other studies found that 41%–42% of U.S. adults delayed or avoided care during the pandemic for fear of COVID-19, including 12% who avoided urgent or emergency care.
• Stay-at-home orders, Medicaid coverage of telehealth in many states, and CDC’s guidance to use virtual visits.

Benefits and limits

Telehealth may have widened access when many offices were closed or had cut their hours, reduced exposure for staff and patients, saved scarce personal protective equipment, and eased the load on facilities — especially valuable for people reluctant or unable to be seen in person, or at high risk of severe COVID-19. But not everyone has internet access, a suitable device, or familiarity with the technology, and some conditions need an in-person exam or tests.

The data come from only four providers and do not capture all virtual care, and the early symptom definition could not separate COVID-19 from influenza-like or other respiratory illness, so some patients may have been misclassified.

The authors conclude that with expanded access, better reimbursement and broad acceptance by patients and clinicians, telehealth could remain an important way to deliver care during and after the pandemic.

Sources

Based on Koonin LM, Hoots B, Tsang CA, et al., "Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, as corrected by its published erratum; a work of the United States government in the public domain.