You’re reading the Benton Institute for Broadband & Society’s Weekly Digest, a recap of the biggest (or most overlooked) broadband stories of the week. The digest is delivered via e-mail each Friday.

Round-Up for the Week of March 9-13, 2020

Broadband makes telehealth, telework, and distance learning possible. But is U.S. broadband up to the task of delivering these services to everyone in the face of the coronavirus (COVID-19)? Both the government and private sector are moving to online systems and operations, but not everyone in the U.S. can easily follow.

Turning to Telemedicine

Large hospitals across the country are quickly expanding the use of telemedicine to safely screen and treat patients for coronavirus, and to try to contain the spread of infection while offering remote services, the New York Times reported this week. The Wall Street Jounal looked at the role of hospital chief information officers who are putting in place new systems and workflows to get ahead of the growing epidemic that threatens to tax limited resources and staff. Their tasks include greenlighting telemedicine projects to reduce expected patient gridlock, developing digital dashboards to speed triage, and testing and retesting systems expected to allow staff to work remotely. Some health systems are fast-tracking planned technology projects such as telemedicine, aimed at screening patients without requiring them to visit a hospital.

Health insurance plans do typically offer people the option of talking to a nurse or doctor online as an alternative to heading to an emergency room or urgent care center, but most people don’t make use of it. Now doctors, hospital networks, and clinics are rethinking how the technology can be used to steer the most at risk to the proper treatment.

Telemedicine got an additional boost under the $8.3 billion emergency funding measure from Congress, which loosened restrictions on its use to treat people covered under the federal Medicare program. Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, praised the government’s efforts to expand the use of telemedicine under Medicare, the federal program for people 65 and older. Private health insurers also said they would pay for the virtual visits for people who may have coronavirus to improve access to care for their customers.

By using their phone or computer, patients will be able to get guidance about whether they need to be seen or tested instead of showing up unannounced at the emergency room or doctor’s office. Patients, particularly those who would be at high risk for a serious illness if they were infected, can also opt to substitute a trip to a doctor’s office with a virtual visit when it is a routine check-in with a specialist or a primary care doctor. That way they can avoid crowded waiting rooms and potential infection.

Providing caregivers easy access to data about the coronavirus is proving to be a top task for hospital CIOs. Executives are also adjusting workflow systems so doctors have a single source to access all the data needed to screen patients and determine if they need to be isolated. 

But, as former-FCC Commissioner Mignon Clyburn noted, rural communities face limited access to health-care facilities and physicians—and too many are also digitally isolated. A  University of Pittsburgh study illustrates that where there are fewer doctors, there is also less broadband:

• Counties with adequate access to primary care physicians and psychiatrists had 62 percent broadband coverage;
• Counties with inadequate access to primary care physicians had 39 percent broadband coverage; and
• Counties with inadequate access to psychiatrists had 49 percent broadband coverage.

Obviously, telehealth will not reach people in digitally-isolated communities. Nowhere is bridging the digital divide more critical than in the area of health care.

I'm Working From Home

As part of China's response to COVID-19, tens of millions of workers were forced to work from home. Are we ready for that in the U.S.? 

The San Francisco Bay Area is employing remote work more than any other area in the U.S. this month in response to the coronavirus. Traffic is light. Subway cars are carrying about three-quarters of their usual payload. Hundreds of thousands of employees from companies including Apple, Facebook, Twitter, Google, Lyft, Intel, LinkedIn, Microsoft, and HP have been told they could work from home.

The Trump administration is racing to develop contingency plans that would allow hundreds of thousands of federal employees to work remotely full time, an extreme scenario that would test whether the government can carry out its mission from home offices and kitchen tables. The Office of Personnel Management, which oversees policy for the workforce of 2.1 million, has urged agency heads in recent days to “immediately review” their telework policies, sign paperwork with employees laying out their duties, issue ­laptops, and grant access to computer networks.

About 12 years ago, with broadband technology in many homes, telework became a key feature of federal continuity of operations plans. But the plans have yet to be activated on a wide scale. The closest call was during the H1N1 pandemic of 2009, a novel influenza virus known as swine flu. The government ramped up for a robust response, but no federal offices were affected.

Close to half the federal workforce was eligible to telework when President Trump took office, on average one or two days a week, for snow days or sporadically. But few did it full time. Then the Trump administration scaled back working from home as a regular practice at multiple large agencies. Now managers are scrambling to expand the policy. Employees who now telework a day or two a week could expand to full time. Others could work from home for the first time.

But managers are realizing that shifting gears is not as simple as telling someone to power up their computer at home. Not everyone has broadband access at home — or a government-issued laptop that’s generally required to telework. Employees need access to agency networks. Some of their work contains sensitive material that can’t be exposed in a home setting.

Some DC-area House Democrats are furious about the cuts and they introduced legislation to force the administration to reinstate telework where it has been curtailed.

Are We Leaving Kids Behind?

Earlier this month, the United Nations estimated that school closures in 13 countries were impacting 290 million students. That has left millions of teachers, administrators, and students at the mercy of online learning, much of which is unfamiliar, and untested at such a scale. Schools across the U.S. are closing temporarily to protect their students. But if school closings become widespread and long-term, how will it impact learning and burden families? Many fear the impact on students at schools with fewer resources, and the potential of these unique circumstances to widen the already gaping divides in education.

This unprecedented remote-learning situation is expected to expose the tech gap between affluent and lower-income families and districts, as well as between urban and suburban districts and rural ones where high-speed internet doesn’t always exist.

Rose Luckin, a professor of learning-centered design at University College London, says there are many reasons to worry about the prospect of scaled remote learning: insufficient infrastructure (not everywhere has stable and reliable broadband connectivity); technology (not all schools have the tech they need or the technical support to make it happen); human resources (few schools have the teacher capacity to created well-designed online materials), and home technology: not all homes have the tech needed—hardware or software—to make it happen.

Estimates on the number of U.S. households with school-age children who lack home internet access range from 6 million to 7 million, according to government data. Approximately 17% of U.S. students don’t have computer access at home and 18% don’t have access to broadband internet at home, according to an Associated Press analysis of census data last year.

And, although individual schools and districts are hashing out plans to support online classes for students who don't have in-home broadband, it's a huge challenge to do so on a broader scale. "I don’t think the schools are adequately prepared to provide online learning to all of their students at home if they have to close for a long period of time," said John Windhausen, executive director of the Schools, Health & Libraries Broadband Coalition. "It could be better than having no school whatsoever, but there are an awful lot of questions about how to do so fairly."

Even in households with broadband access, many parents are wondering whether their internet data plans will have the capacity to handle so much usage at once. Christopher Mitchell of the Institute for Local Self-Reliance writes that historic inequities will be exacerbated—people that have been able to afford the high-quality networks will probably see very little disruption and those who have older networks may be effectively disconnected. Those on fiber optic networks probably won't notice major changes in demand. And most modern cable networks should be also able to handle the demand—especially on the download end. In the upstream direction, the cable networks will have some challenges. 

Fixed Wireless networks will be all over the board. Urban and advanced fixed wireless networks will probably scale just fine. But in rural areas, many fixed wireless networks were constructed without the headroom for the expected increase in demand. DSL will be an unmitigated disaster in many places, especially where Frontier and Windstream are the monopoly, Mitchell writes. These networks may become unusable.

Enter the FCC?

On March 5, Sen. Maria Cantwell (D-WA), the Ranking Member on the Senate Commerce Committee, called on Federal Communications Commission Chairman Ajit Pai to do whatever he can to promote telehealth and remote schooling, asking the agency to explore temporary measures and "facilitate at-home connectivity for students to keep up in class should remote schoolwork become necessary due to COVID-19 closures.” 

In Senate testimony this week, fellow-FCC Commissioner Jessica Rosenworcel said the agency should be exploring how it can use its funding to help schools loan out Wi-Fi hotspots to students whose classes have shifted online. She also pointed to legislative efforts from Sen. Chris Van Hollen (D-MD) and Rep. Grace Meng (D-NY) that could help by allocating money to increasing broadband access for school kids.

"Those types of solutions could be tremendously valuable right now to the millions of families trying to figure out how their child can get online and get their homework done if their school closes," said Commissioner Rosenworcel.

"Coronavirus, without some immediate changes being made, is certainly going to exacerbate the haves and have nots for who's digitally connected," said Fellow-FCC Commissioner Geoffrey Starks. He wants to see the agency direct Universal Service Fund support toward helping serve connectivity needs laid bare by coronavirus. 

Starks also offered a number of proposals, including:

• Expediting waivers and experimental licenses that will expand network capabilities; creating additional Wi-Fi capacity by temporarily authorizing use of the 5.9 GHz band.
• Awarding grants for capacity upgrades in underserved communities impacted by the coronavirus.
• Encouraging providers to offer lowcost program options that could extend a basic internet connection for millions of Americans and to deploy their emergency assets, such a cell sites on wheels, to unserved communities.
• Consider an emergency distribution of funds to rapidly increase the number of lendable hotspots available through schools and libraries.
• Consider increasing the amount of money Lifeline—the only federal program designed to bring affordable communications to our most vulnerable Americans—provides for basic connectivity, raising data caps, and easing enrollment burdens.

"We need to think creatively on how we're going to help the American people through a time of crisis," said Commissioner Starks. "I firmly believe that families are going to rely on connectivity in a way that they've never done before. And the FCC has to lead."

At a Congressional hearing this week, Chairman Pai did not directly address providing temporary access to schools to help bolster online access to coursework amid the coronavirus outbreak, other than to say in opening remarks that the FCC's top priority is to close the digital divide, especially in rural areas.

"That's a crisis," Commissioner Rosenworcel said of the 12 million students without internet access at home. "But now with the coronavirus we have real duties to figure out how to help get those kids online. Because when their schools shut down and their classes migrate online they are at the greatest risk of being left behind."

Rosenworcel released a statement March 12 saying:

Quick Bits

• Senate Unanimously Passes Broadband DATA Act (Multichannel News)
• Senate Commerce Committee Approves ACCESS BROADBAND Act (Multichannel News)
• Musk's SpaceX Looking to Compete for $16 Billion in Federal Broadband Subsidies (Wall Street Journal)
• "Online first" census must navigate digital divide (Axios)
• FCC's March Agenda (Federal Communications Commission)

Weekend Reads (resist tl;dr)

• Here's how Silicon Valley is helping Washington respond to coronavirus (Washington Post)
• Healthcare From Anywhere (Connected Nation)
• States Look to Improve Upon Incomplete FCC Broadband Data (Government Tech)
• How Cleveland is bridging both digital and racial divides (Brookings)
• Why the web needs to work for women and girls (World Wide Web Foundation)

ICYMI from Benton

• Want to solve America’s problems? Start with broadband (Adrianne Furniss)
• Four Steps Towards E-Rate Connectivity and Competition (Jonathan Sallet)
• Community Anchor Institutions as Launching Pads for High-Performance Broadband Deployment (Jonathan Sallet)
• Tell The Story We Know: Broadband Competition is Too Limited (Jonathan Sallet)
• Lack of Broadband Leaves Students Behind (Kevin Taglang)

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The Benton Institute for Broadband & Society is a non-profit organization dedicated to ensuring that all people in the U.S. have access to competitive, High-Performance Broadband regardless of where they live or who they are. We believe communication policy - rooted in the values of access, equity, and diversity - has the power to deliver new opportunities and strengthen communities.

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