Many hospitals, clinics and dental offices in some places across the U.S. are beginning to open now for routine, preventative care that was postponed in the early days of the coronavirus pandemic. But still, patients wonder: Is it safe to go?
Michael LeVasseur, a visiting assistant professor of epidemiology and biostatistics at Drexel University in Philadelphia, says a lot of his friends and family members have been asking him that question, along with other queries about the pandemic. So many questions that he put together two YouTube videos to try to address them at once.
LeVasseur's general advice is to contact your doctor — the best advice for you may still vary, depending on your situation and where you live. But he says he's confident that physicians who are accepting patients will be cleaning their offices regularly and taking other precautions to prevent the spread of the coronavirus.
Neal Goldstein at Drexel University and Aimee Palumbo at Temple University, both epidemiologists, urge a number of specific precautions that concerned patients can ask medical and dental staff about when scheduling an appointment:
Many of the offices and hospitals opening back up for elective and routine medical appointments in the Philadelphia area highlight other precautions they are now taking, too, such as screening patients by phone a day or two ahead of the appointment for any sign of illness, checking for fever at the hospital entrance and testing patients for COVID-19 ahead of procedures.
For most routine checkups, the decision about whether to start getting preventive care again should be easy, Palumbo says: "The people that are at highest risk of COVID or poor outcomes from COVID are also the ones that ... are going to benefit the most also from these routine procedures, so we have to recognize that these things still do need to happen. It's better to treat something sooner than later, so it is still important to continue their care even while this is going on."
Neil Fishman, an infectious disease specialist and chief medical officer at the Hospital of the University of Pennsylvania, says that, broadly speaking, fewer patients have been coming in to medical offices with routine medical problems. That worries him.
"We know COVID-19 did not cure cancer, COVID-19 did not cure heart disease," he says, "so that means that there are a lot of people who have been afraid to get routine health care either for existing conditions or for ... as-yet-undiagnosed conditions.
"It's critical," Fishman adds, "for people to get [regular] physical exams, to get gynecologic checkups, to get mammograms, and colonoscopies, and particularly flu shots during cold and flu season."
"We have seen what a world without vaccines looks like," he says. "It looks like this pandemic that we're experiencing — and it would be even more devastating if we saw a recurrence of vaccine-preventable illnesses because people are avoiding health care out of fear."
Some of that avoidance of care that should continue has already happened. A report from the Centers for Disease Control and Prevention last month showed a drop in vaccinations among children age 2 or younger in Michigan during the pandemic, compared with similar periods in the past few years.
"The observed declines in vaccination coverage might leave young children and communities vulnerable to vaccine-preventable diseases such as measles," the authors write. "If measles vaccination coverage of 90%–95% (the level needed to establish herd immunity) is not achieved, measles outbreaks can occur."
At the same time, it can be difficult to talk to patients about coming back for routine appointments. In a May 27 editorial in the medical journal JAMA: Internal Medicine, David Asch, a professor of medicine and health policy at the University of Pennsylvania, writes that "the biggest challenge in helping patients feel safe is doing so in a way that is not itself scary."
"Hospitals should pay attention to how they may be perceived to ensure that they do not inadvertently scare away the patients who need them," Asch writes.
Fishman at Penn Medicine agrees.
"People are anxious when they're visiting physicians or other health care providers; the anxiety is going to be ever more increased by the changes that COVID-19 are mandating now," he says. "I always try to think about how a patient would feel — how my mother would feel — if they saw someone walking in the room with a mask and a face shield on, because that's not what you normally experience."
Fishman has, indeed, talked to his mother, who has a chronic illness and was briefly hospitalized at the beginning of the pandemic, about whether she should go to her routine follow-up visits. He says she goes to those appointments — but he does the grocery shopping for her to reduce the risks she might encounter there.
There are some procedures that might be done virtually or just postponed. Jeffrey Jahre, an infectious disease specialist at St. Luke's University Health Network in Bethlehem and senior vice president of medical and academic affairs, says physical therapists at St. Luke's have been seeing a lot more patients virtually.
The American Physical Therapy Association released general guidelines for their members in May, suggesting virtual visits for patients who are at risk of getting severely ill from a COVID-19 infection or who are concerned about an inpatient visit – especially if the alternative to a virtual visit is no care at all.
Many dental offices are open in Philadelphia, says David Tecosky, a dentist in the city, though most still have not returned to doing cosmetic procedures, such as applying custom-made veneers to cover the front of stained or chipped teeth.
Tecosky says he has a two-month or longer backlog of appointments and is starting to again see patients for preventive checkups, as well as emergency procedures to treat infections or cracked teeth that could lead to pain and problems with eating. He recommends calling your dentist if you've missed an appointment in recent months because of the pandemic to see if it's time for you, too, to reschedule.
While a dentist might have scheduled 10 patients a day before the pandemic, Tecosky notes that can't happen now, with the various social distancing measures that need to be taken into account, along with the new need to change gowns and other personal protective equipment between patients. Tecosky now wears hairnets, for example, which he wasn't doing before the pandemic.
His offices has also added new measures to protect staff and patients — such as plastic screens at the front desk, more distance between waiting room chairs, and curtains in the operating area. The CDC has more detailed guidance for dental settings.
Tecosky says he and his whole team have been taking patients' phone questions in recent weeks, and the patients calling have not been reluctant to come back for appointments.
"Even though dentistry is not known to be a place that people flock to go to because they love to, we are finding that patients are not canceling appointments or ... saying, 'Oh, I don't want to come in,' or 'Wait six months' or 'I'm going to wait 'til this all passes.' "
However, he says, he expects the pandemic will produce lasting changes to how dentists practice. For one thing, masks that used to cost $10 now cost $30. Early in the pandemic, he says, he had to put most of his staff of six or seven people on temporary furlough because the office was only permitted to provide urgent care initially. They are all back at work now, Tecosky says, but the office is only getting around 20% of the money earned in pre-pandemic times — far below the amount needed to cover overhead costs. All dentists, he says, will keep trying to figure out ways to get patients the care they need, but it could mean a rise in fees.
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