Dr. Steven Douglas of East Prairie has settled into a new routine in recent weeks.


He sees his well-patients, those not showing symptoms indicating a respiratory illness, in the morning. In the afternoon he meets with patients complaining of a cough, sore throat or fever – trademark signs of COVID-19, and schedules telehealth visits when he can.


On Mondays, there is one addition. He goes to his office, logs onto his computer and tunes into the University of Missouri’s COVID-19 ECHO.


“It’s a remote learning tool that they use because of the ruralness of the state,” Douglas said. “They have been doing this for a long time. Three weeks ago, they started one for COVID-19.”


The program was created five years ago to help rural practitioners expand their knowledge of sub-specialty practice. Douglas participated in one of the first ECHOs on Hepatitis C prevention and care. Since then, the program has covered diabetes, dermatology, and now telehealth and COVID-19.


“We can help that local provider deliver care that may before may be out of their scope,” Senior Medical Director of Missouri Telehealth Network and the Show Me ECHO Program Dr. Karen Edison said.


Not only does it keep health care local by decreasing the necessity of a hospital visit, but it creates a professional network for rural providers, Edison said.


Douglas lives in Mississippi County in what he calls “the end of the road in Missouri.” It’s in the southeast of the state just across the Mississippi River from Kentucky. In some ways, he said, its location has offered residents some protection. There is yet to be a known case of COVID-19 in Mississippi County.


“We don’t have a lot of travel through the county,” he said.


That said, when it comes to the possibility of a COVID-19 outbreak, the margin of error is slim.


There is no hospital in Mississippi County, meaning no ICU beds. Sikeston is 20 miles north and Cape Girardeau is another 40 miles.


Douglas was able to start testing patients for the illness in his clinic about two weeks ago. His affiliation with Saint Francis Hospital System has helped him access personal protective equipment, but not all Missouri health care providers have fared so well.


On April 14, The Missouri Hospital Association reported that 29 hospitals were experiencing a shortage of N95 masks despite contingency plans in place. Four were experiencing a critical shortage, meaning they had less than a two-day supply. By April 17, those experiencing a shortage had decreased to 25, but those with a critical shortage had risen to five.


But equipment isn’t the only thing necessary in fighting COVID-19. Information is equally as important, especially with a disease as unknown as COVID-19.


“It is a rapidly changing territory right now,” Douglas said. “With (the ECHO) you can at least have confidence you have the best available information.”


With little known about COVID-19 and direction for its treatment constantly changing, information from a reliable source is vital to containing the illness.


In the words of Katy Trail Community Health CEO Chris Stewart, it is “critical, critical, critical.”


Katy Trail Community Health is headquartered in Sedalia in Pettis county, but serves Saline, Morgan and Benton counties as well. Stewart said the chief role of her clinic is to keep people from going to emergency rooms unnecessarily. That means screening possible COVID-19 patients and administering tests.


But to do that, clinicians must know how to administer a test and which media to store it in. Both of which are topics covered in University of Missouri’s COVID-19 ECHO series.


“Oh my goodness, there are just a gazillion questions,” Edison said. “What kind of masks do I have to have? Where can I get testing? What kind of media can I put it in? What if I run out? The questions just go on and on and on.”


Not only does Edison facilitate the answers to those questions, but she invites University of Missouri doctors to present COVID-19 cases. This gives rural practitioners the opportunity to consider how they might treat a case of COVID-19 long before they have a positive test. Edison said over 300 health care providers over three states participated in the most recent COVID-19 ECHO meeting.


“That’s the beauty of ECHO,” Edison said.


Edison has been a long-time advocate for telehealth’s ability to bridge the rural health disparity. She practiced tele-dermatology for 26 years and now sees the ECHO series as a continuation of those efforts.


Instead of treating just one patient at a time, she can help educate practitioners on how to treat hundreds of patients. And now, as Missouri practitioners are all grappling with how to treat the same illness, she says that’s more necessary than ever.


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