It has almost become a cliché: COVID-19 is not the great equalizer that we initially thought. It has widened the existing cracks and shone a light on existing inequities. And what we can see from the front lines of the emergency room is that access to a phone is even more essential, and the lack of phone connectivity even more unjust.
As physicians, we have always been frustrated when we are unable to reach patients by phone. Communicating the results of important medical tests, arranging follow up or simply a call to see how people are doing after discharge — none is possible without a phone. Some patients are even kept in hospital unnecessarily because they lack access to a phone for follow up arrangements.
Then COVID-19 arrived. Positive COVID-19 test results are given by phone. Contact tracing is done by phone. Those awaiting their results or with symptoms, or close contacts of people with COVID-19, must self-isolate, essentially running their lives via phone. Access to health care is now almost entirely done by video conferencing and by phone.
For most, this rapid change in the health care landscape has been positive, as a patient-centred, appropriate use of technology that reduces the sunk cost of taking time and money to get the doctor’s office. But how do we ask people to self-isolate, to get groceries, to get health care, to get help, and to connect to friends and family without a phone?
We decided to do something — small to start — to address this glaring gap in our ability to provide care on the front lines. In partnership with telecommunications companies, UHN, Unity Health, Michael Garron, and South Riverdale Community Health Center, we have come together under a PHONE-CONNECT working group to “prescribe” cellphone access to our emergency department and primary care patients, offering prepaid sim cards and phones who need them. We ask patient permission to call in a few weeks to see how they are doing and how they’re using their phone.
Our initial findings are dramatic. Recipients have used phones to connect with family doctors, addictions counsellors, social workers, medical specialists, Toronto Public Health representatives, and they have used them to attend telemedicine appointments.
They have used their phones to order groceries, secure shelter beds, and contact 211. There have also been examples of patients using their phones to call suicide hotlines and receive sexual assault counselling. Many have used their phones to speak with friends and family, and many report strengthening their social networks by virtue of being in regular contact.
Some have even positively reconnected with estranged family members, been in touch with loved ones abroad, received job notifications and school assignments. Overwhelmingly, recipients report a positive impact on their overall well-being.
It makes us think, what would happen if we hadn’t provided a phone? Most of us take our cellular phones for granted. While we complain about the high cost of data and cellular phone access, we will find the money, as our phone is so essential to our day-to-day functioning and communication. This is why telecommunications is considered a vital aspect of digital equity, and indirectly acts as a social determinant of health.
We need to go beyond “Discharge home and follow up with your family doctor.” COVID-19 has brought homelessness, social isolation, poverty, and other determinants of health into sharp focus.
We think putting digital equity at the centre of care helps address urgent health imperatives, provide some human dignity, and be the first step toward improving the health and wellness of the most marginalized in our society.
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