3  COVID‐19 PANDEMIC
It could not be more fortuitous that this special issue was scheduled to go to print amidst the COVID‐19 pandemic, which has dramatically altered the telepsychology and telemedicine landscape in the United States and in other global regions. The World Health Organization (WHO) was informed on December 31, 2019 that several cases of pneumonia of unknown etiology were detected within China's Hubei province (WHO, 2020a). On January 7, 2020, Chinese health authorities announced they had identified and isolated a new type of coronavirus (i.e., 2019‐nCoV, COVID‐19, or coronavirus) associated with the cluster of detected respiratory infections within Wuhan city. Five days later, China shared the genetic sequence for the virus with other countries to develop diagnostic testing. By January 20, a total of 282 cases of COVID‐19 had been detected across China, Thailand, Japan, and the Republic of Korea (WHO, 2020a).
On January 19, a 35‐year‐old male entered an urgent care clinic within Washington State after several days of coughing, nausea, and a fever. Before seeking treatment, he had been visiting family in Wuhan, China and had returned to the United States. On the following day, the Centers for Disease Control and Prevention (CDC) confirmed that the man's nasopharyngeal and oropharyngeal swabs had tested positive for COVID‐19 (Holshue et al., 2020). By the end of February, 85,403 COVID‐19 cases had been confirmed globally, with 62 total cases confirmed within the United States (WHO, 2020b). On March 11, 2020, the director of the WHO announced that they had characterized the COVID‐19 virus as a pandemic (WHO, 2020d).
During crisis‐related surges in health care needs, effective strategies have been developed to help patients and communities manage acute stress, preserve medical supplies, and maintain the mental and physical health of patients and health care staff (Tadmor, McManus, & Koenig, 2006). For example, in anticipation of higher demand, and to decrease the risk of virus transmission between individuals, the CDC and the American College of Surgeons (ACS) recommended that health care providers postpone elective procedures and routine patient visits (ACS, 2020; CDC, 2020). As projections revealed major metropolitan areas had insufficient capacity to meet anticipated demand, temporary health care facilities were established in public spaces such as the New Orleans Convention Center (The Associated Press, 2020), New York's Javits Center (Lardieri, 2020), and Central Park (Torres, 2020). Also, the hospital ships United States Naval Ship (USNS) Comfort and USNS Mercy were deployed to New York and Los Angeles to serve patients without the virus (Correll, 2020; U.S. Naval Institute, 2020).
Based on the speed of transmission and delayed onset of symptoms of COVID‐19, the WHO strongly recommended physical distancing between individuals (WHO, 2020c) to avoid overwhelming health care infrastructure. Guided by this, large gatherings were canceled, many schools shifted to web‐based learning, companies adopted telecommuting for employees (Adalja, Toner, & Inglesby, 2020), and health care organizations greatly expanded their use of telehealth (Nitkin, 2020; Stiepan, 2020; VHA, 2020). The need for physical distancing during the pandemic comes at a psychological cost for communities. There exists a rich body of literature revealing a relationship between social support and mental health (Harandi, Taghinasab, & Nayeri, 2017). Catastrophes and disasters are associated with higher levels of psychological distress, depression, anxiety, panic, posttraumatic stress disorder, and interpersonal problems in affected communities (Norris, Friedman, & Watson, 2002; Norris, Friedman, Watson, Byrne, et al., 2002). Furthermore, the stress and anxiety that communities experience during periods of heavy media coverage of a disease have been associated with a surge in patient volume within emergency departments several days before the actual arrival of an epidemic within the community (McDonnell, Nelson, & Schunk, 2012). Physicians have also reported experiencing distress and psychological trauma after being forced to make difficult ethical decisions about the allocation of resources during the COVID‐19 pandemic (Shurkin, 2020).

3.1  National deployment of telemedicine amidst COVID‐19
This troubling mix of isolation and psychological distress makes it vital for psychologists to have flexible options for treating patients and communities. As noted in this special issue, the use of telepsychology and telemedicine can enable skilled providers of mental and physical health care quickly to shift their focus to the locations where they are needed the most at any given time. It allows them to treat people in areas that may be difficult or dangerous to travel to, or would limit productive time if they were required to travel in person to multiple sites (Darkins, 2016; Tadmor et al., 2006). Telepsychology also provides an opportunity for psychologists in rural areas to contribute to the surge capacity of larger communities during a crisis (Tadmor et al., 2006).
Recognizing several longstanding impediments to telepsychology's and telemedicine's adoption, agencies within the U.S. government quickly pivoted on multiple policies, unleashing telepsychology's and telemedicine's ability to play an important role in delivery or care during the COVID‐19 pandemic. On March 16, 2020, the “in‐person” requirement set forth by the Ryan Haight Act was suspended indefinitely, allowing practitioners to prescribe Schedule II–V controlled substances as long as the exam occurred using a two‐way, audio‐visual, real‐time communication system (U.S. Drug Enforcement Administration Diversion Control Division, 2020). Additionally, Medicare and Medicaid temporarily increased access to care by allowing psychologists, licensed clinical social workers, physicians, and nurse practitioners to be reimbursed for telepsychology and telemedicine visits with patients across the country, including within patients' homes, and at the same rates as in‐person visits (U.S. Centers for Medicare & Medicaid Services, 2020). The American Psychological Association advocated for reimbursement parity for telepsychology sessions conducted by phone only (DeAngelis, 2020). The Department of Health and Human Services' Office for Civil Rights (OCR) also temporarily waived the HIPAA Security and Privacy Rule requirements that had previously prevented the use of common communications apps such as FaceTime and Skype (U.S. Department of Health and Human Services' Office for Civil Rights, 2020a, 2020b). These important changes in response to the global emergency highlighted the numerous, long‐standing obstacles to telepsychology and telemedicine adoption that have resulted from policies and regulations within the United States.
In response to unprecedented public demand for their services, telepsychology and telemedicine providers such as Doctor on Demand, Teladoc, and American Well began recruiting psychologists and physicians as demand outstripped their current capacity (Pifer, 2020). Unfortunately, the increased video conferencing and streaming services demands pushed the limits of the infrastructure and personnel that support the Internet. Ookla, a company that monitors and provides network speed reports, observed diminished global network speeds and higher latency levels during March, 2020 (Ookla, 2020). Atlas, a virtual private network (VPN) provider, reported a 53% increase in VPN usage during the second week of March in comparison to the previous week (Atlas, 2020). As a result, this made telepsychology and telemedicine adoption more difficult. For example, VA employees experienced problems with very slow data transfer rates and network instability. This made it difficult for patients, psychologists, and physicians trying to leverage the VA's VideoConnect telemedicine platform (Tahir, 2020), laying bare some of the technological challenges still present in the use of telemedicine.