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Many hospitals, clinics, and dental offices in some locations around the United States are now opening for routine, preventative care that has been postponed during the early days of the coronavirus pandemic. But patients still wonder: Is it safe to walk?
Michael LeVasseur, guest assistant in epidemiology and biostatistics at Drexel University in Philadelphia, says many of his friends and family members have asked him that question, along with other pandemic questions. So many questions that he put together two YouTube videos to try to address them all 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 is convinced that doctors who receive patients will clean their offices regularly and take other precautions to prevent the spread of coronavirus.
Neal Goldstein at Drexel University and Aimee Palumbo at Temple University, both epidemiologists, urge a number of specific precautions that affected patients may ask medical and dental professionals when planning a time:
- Do staff and patients wear masks all the time?
- Do the staff have enough masks and protective equipment?
- Will there be a limit to how many people can be in a waiting room?
- Are the COVID-19 staff tested?
- How often do the staff clean in waiting rooms and offices?
- If you are not driving, can you take public transport while staying away from other people and washing your hands before and afterwards?
Many of the offices and hospitals open to elective and routine medical appointments in the Philadelphia area highlight other precautions they are now also taking, such as screening patients by phone a day or two before appointments for signs of illness, checking for fever at the hospital inlet and test patients for COVID-19 before procedures.
For most routine checks, the decision to start receiving preventative care should be simple, says Palumbo: “The people who are most at risk for COVID or poor outcomes from COVID are also the ones who … will benefit most also from these routine procedures, so we have to realize that these things still need to happen. It is better to treat something sooner rather than later, so it is still important to continue care even if this is ongoing. “
Neil Fishman, a specialist in infectious diseases and medical director at the University of Pennsylvania Hospital, says that, by and large, fewer patients have entered medical offices with routine medical problems. It worries him.
“We know that COVID-19 did not cure cancer, COVID-19 did not cure heart disease,” he says, “so that means there are many people who have been scared to get routine care either for existing conditions or for … who as yet undiagnosed conditions.
“It’s critical,” Fishman adds, “for people to get [regular] physical examinations, to get gynecological checks, get mammograms and colonoscopies, and especially flu shots during the cold and flu season. “
“We have seen what a world without a vaccine looks like,” he says. “It looks like this pandemic we are experiencing – and it would be even more devastating if we saw a relapse of vaccine-preventing diseases as people avoid the fear of health care.”
Some of this avoidance of care that should continue has already happened. A report from the Centers for Disease Control and Prevention last month showed a decrease in vaccinations among children ages 2 or younger in Michigan during the pandemic, compared to similar periods in recent years.
“The observed reductions in vaccination coverage may leave young children and communities exposed to vaccine-preventing diseases such as measles,” the authors write. “If measles vaccination coverage of 90% –95% (the level required to establish herd immunity) is not achieved, measles outbreaks may occur.”
At the same time, it may be difficult to talk to patients about returning to routine appointments. In an editorial on May 27 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 to do so in a way that is not is itself scary. “
“Hospitals should pay attention to how they can be perceived to ensure that they do not inadvertently scare away patients who need them,” Asch writes.
Fishman at Penn Medicine agrees.
“People are worried when they visit doctors or other healthcare providers; anxiety will increase more and more of the changes that COVID-19 requires now,” he says. “I always try to think about how a patient would feel – how my mom 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 actually talked to her mother, who has a chronic illness and briefly admitted to the hospital at the beginning of the pandemic, if she should go for her routine follow-up visits. He says she goes to these meetings – but he acts for her to reduce the risks she may encounter there.
There are some procedures that can be done practically or just postponed. Jeffrey Jahre, specialist in infectious diseases at St. Luke’s University Health Network in Bethlehem and senior vice president of medical and academic affairs, says physical therapists at St. Luke has seen many more patients practically.
The American Physical Therapy Association released general guidelines for its members in May, suggesting virtual visits for patients at risk of being seriously ill with a COVID-19 infection or who are worried 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, although most have still not returned to do cosmetic procedures, such as applying customized veneers to cover the face of colored or chipped teeth.
Tecosky says he has a two-month or more regular regular meeting and is once again beginning to see patients for preventative checks, as well as emergency procedures to treat infections, or cracked teeth that can lead to pain and eating problems. He recommends that you call your dentist if you have missed a meeting in recent months because of the pandemic, to see if it is also time for you to plan again.
While a dentist may have scheduled 10 patients a day before the pandemic, Tecosky notes that this cannot happen now, with the various social distance measures that must be considered, along with the new need to change dresses and other personal protective equipment between patients. Tecosky now wears hair nets, for example, which he did not do before the pandemic.
His office has also added other new measures to protect staff and patients – such as plastic screens at reception, more distance between waiting room chairs and curtains in the operating area. CDC has more detailed guidance for dental settings.
Tecosky says he and his entire team have been addressing the patient’s phone questions in recent weeks, and the callers have not been reluctant to return for meetings.
“Although dental care is not known to be a place that people flock to go to because they love it, we find that patients do not cancel appointments or … say, ‘oh, I don’t want to come in,’ or ‘ Wait six months’ or ‘I’ll wait’ till everything goes well. “”
But he says he expects the pandemic will bring lasting changes in how dentists exercise. 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 on six or seven people on temporary furlough because the office was only allowed to provide emergency care initially. They are all back at work now, Tecosky says, but the office receives only about 20 percent of the money earned in the time before the pandemic – well below the amount needed to cover costs. All dentists, he says, will continue to try to find ways to get patients the care they need, but that could mean an increase in fees.
Alan Yu reports on space, science and innovation for WHYY in Philadelphia, where this story originally appeared.