No abstract

Background: Disparities in telemedicine use by race, age, and income have been consistently documented. To date, research has focused on telemedicine use among patients with adequate insurance coverage. To address this gap, this study identifies patient-level factors associated with telemedicine use during the coronavirus (COVID-19) pandemic among one free clinic network's patients who are underinsured or uninsured. Materials and Methods: Electronic health record data were reviewed for patient-level data on patients seen from March 2020 to September 2020. Patients were grouped by telemedicine use history. We controlled for sociodemographic factors (e.g., age, race/ethnicity) and comorbidities. Logistic regression analyses were conducted. Results: Across 198 adult patients, 56.6% received telemedicine care. Of these, 99.1% elected for audio-only telemedicine instead of video telemedicine. Telemedicine use was more likely among those living within 15 miles of their clinic (adjusted odds ratio [aOR] = 4.43, 95% confidence interval [CI] 1.70-11.53). It was less likely to be used by older patients (aOR = 0.97, 95% CI 0.94-1.00), patients of male sex (aOR = 0.85, 95% CI 0.18-0.92), and those establishing care as a new patient (aOR = 0.01, 95% CI 0.00-0.07). Conclusion:The moderate usage of telemedicine suggests that its implementation in free clinics may be feasible. Solutions specific to patients with smartphone-only internet access are needed to improve the use of video telemedicine as smartphonespecific factors (e.g., data use limits) may influence the ability for underserved patients to receive video telemedicine.

Virus SARS-CoV MERS-CoV Type of coronavirus Lineage b betacoronavirus Lineage c betacoronavirus Host cell receptor Angiotensin converting enzyme 2 Dipeptidyl peptidase 4 Animal hosts Chinese horseshoe bats, palm civets Not yet confirmed, but camel is likely host Incubation period Mean (95% CI; days) 4.6 (3.8-5.8) 5.2 (1.9-14.7) Range (days) 2-14 2-13 Serial interval (days) 8.4 7.6 Basic reproduction number 2-3 <1 Patient characteristics Adults 93% 98% Children 5-7% 2% Age range (years) 1-91 1-94 Average age (years) Mean 39.9 Median 50 Sex ratio (M:F) 43%:57% 64.5%:35.5% Mortality Case fatality rate overall 9.6% 40% Case fatality rate with comorbidities 46% 60% Time (days) from symptom onset to hospitalization 2-8 0-16 Time (days) from symptom onset to death 21 12 TABLE 2 Chronology of key events a,b Date Key events April 2012 Cluster of 13 patients in a hospital in Jordan with acute respiratory illness; two deceased patients of this cluster were retrospectively diagnosed (in September 2012) through study of stored specimens with MERS-CoV (5, 90)

Middle East respiratory syndrome coronavirus (MERS-CoV) is a newly emerging respiratory virus. It was first identified in Saudi Arabia in 2012. MERS-CoV infection is characterized by a spectrum of illness ranging from mild to acute and fulminant disease. The majority of patients present with fever, fever with chills/rigors, cough, shortness of breath, and dry cough. Cases of human-to-human transmission have been documented. There is currently no specific treatment and vaccination for MERS-CoV infection. Surveillance and infection-control measures are of vital importance to an efficient public health response. J Microbiol Infect Dis 2015;5(2): 93-98