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Routine Care in the Time of COVID-19

Coronavirus information changes quickly, so please take note of this story’s publication date. You can find current recommendations and national outbreak data on the CDC website. Or, if you want local coronavirus updates and stats, check out the department of health website for your state or your city. Enjoy reading and stay safe. Let’s flatten that curve. 


Whether or not you get the coronavirus, it’s likely that many aspects of your daily life, including how you manage your medical needs, will change if they haven’t already. All patients, from ones who rely on regular care to manage chronic conditions to those who only see doctors for checkups and preventive screenings, will need to learn how to use a healthcare system operating in crisis mode.

According to Dr. Frederick Chen, the chief of family medicine at Harborview Medical Center in Seattle, every health system has disaster-preparedness plans in place. “We’re a long way from [disaster] at this point, but it’s hard not to imagine a worst-case scenario,” he says.

Curious how your healthcare access might change in the upcoming weeks or months? Here’s what the experts say. 

How much will the outbreak interfere with routine care?

Everything is contingent on the degree of the outbreak, according to Dr. Michael Chang, an infectious disease physician at UTHealth in Houston. As experts learn more about the coronavirus and its spread, public health officials will continue to release new guidelines for doctors and healthcare facilities.

In the coming weeks, it’s possible (if not likely) that recommendations for social distancing will interfere with routine care, Chang says. “Now that the WHO has declared a pandemic, and there is evidence of community spread throughout many cities in the US, social distancing remains important to try and slow the spread of the disease and ‘flatten the curve’ of patients seeking care,” he says.

Explainers

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How are doctors and health systems preparing to care for patients who don’t have the coronavirus?

Even as coronavirus cases climb higher, Chang says community hospitals and healthcare systems should be planning for how to care for coronavirus patients in a way that doesn’t interfere too much with other patients’ care: “I’d recommend patients be aware of whether their normal providers have a plan in place for people who don’t have coronavirus symptoms but may need routine care.”

Should you avoid going to the hospital?

As a rule, if you have a true medical emergency, it’s a good idea to go to the ER. But during an infectious disease outbreak, it’s best to minimize collecting large numbers of people in one place. That may mean staying away from healthcare clinics or your local emergency room if you don’t absolutely need to go, both to lessen your risk of coronavirus exposure and reduce the patient load for busy providers dealing with coronavirus patients.

“We’re trying to protect patients who are not sick from patients who might be sick, and we’re trying to preserve the capacity of clinics and hospitals,” says Chen.

Should you cancel a doctor’s appointment for the sake of social distancing?

Younger, otherwise healthy people seem to be at a lower risk for coronavirus-related complications, but everyone plays a part in preventing (and curbing) community spread. Even if you don’t have coronavirus symptoms, the CDC recommends re-thinking situations that involve close physical contact with others. If you’re wondering whether it’s a good idea to head to your clinic or another medical setting, Chang recommends contacting your doctor to figure out the best game plan for your care.

“If you know you have an appointment two weeks from today, go ahead and call to see if your provider wants to reschedule,” he says. “Better to be proactive and get those appointments re-scheduled now than wait on hold a few days before.”

Should you anticipate changes to appointments or procedures you’ve already scheduled?

While that may depend on what’s happening in your area, elective procedures are now largely being canceled (to be rescheduled for a later date). Major health systems including Massachusetts General Hospital and New York Presbyterian have canceled all elective surgeries until further notice. A growing number of medical associations, including the American Dental Association and the American College of Surgeons, are advising postponement of non-urgent care across the country. New York City Mayor Bill de Blasio said he would sign an executive order to postpone elective surgeries in order to free up more healthcare workers to focus on coronavirus treatment. 

On that note, make sure your providers have your up-to-date contact information, so they can easily notify you of any changes.

 

If you do go to the doctor, what should you expect?

Chang says it’s more than likely that offices, clinics and hospitals will be screening patients and visitors, and there could be lines to get into a healthcare facility — so carve out extra time for your appointment. It’s also possible that you’ll only be allowed to have a limited number of people  accompany you to procedures or visits.

Can you see a PCP for something unrelated to the coronavirus?

While it’s important to see your doctor if you have a health concern, you don’t want to expose yourself to germs unnecessarily, or risk spreading germs to more vulnerable people. To keep sick people from contaminating others and protect those who aren’t sick, Chen says many health systems are offering telemedicine visits. “We’re trying to sort out a way to prevent everybody from coming to our waiting room, so we can screen them in an e-visit as a triage and have them come in if needed,” he says.

What about seeing a specialist or, say, getting your teeth cleaned?

That depends on where you live. If there’s no outbreak in your area, it may be business as usual until further notice, but your provider’s office should let you know if anything changes.

Since COVID-19 precautions are always evolving, try to be understanding if your provider reschedules your appointment several times. “It’s not that providers are disorganized; it’s just that new information about how to handle the situation keeps coming out,” says Chang. “The key is good communication on both sides.”

If you’re planning to venture into a healthcare setting, for any reason, it’s best to wash your hands thoroughly both beforehand and afterward. Don’t hesitate to wipe down chairs or other high-touch surfaces, either.

Will pharmacies stay open?

“It is difficult to predict exactly how the virus will impact daily life,” says Dr. Jessica Nouhavandi, the lead pharmacist, founder and CEO of Honeybee Health, an accredited online pharmacy.

So far, Nouhavandi says, pharmacies seem to be open in countries having outbreaks. “In Italy’s recent quarantine of 10 towns, all businesses and stores were closed except for pharmacies and supermarkets.” In some cases, though, pharmacists are limiting contact with patients. There’s one pharmacy in China, Nouhavandi says, that sells only through a window. “In Iran, increasingly long lines are forming outside of pharmacies and inventory is running low.”

How can you make sure you have the medicine you need?

If there’s a regular medication you take, Chen says it makes sense to keep a few months’ supply on hand in case of a drug shortage or an outbreak in your community.

“This is especially important for anyone who takes daily medications to treat a chronic condition such as high blood pressure, high cholesterol, diabetes, depression and migraines, among others,” says Nouhavandi.

Sometimes healthcare providers like to see patients before they’ll refill prescriptions, but they may be more flexible given the outbreak. Insurance companies, which sometimes won’t pay for early refills, are also being more lenient in certain cases and approving early refills. If an insurer refuses to do that, you have the option of paying cash (if you can afford to) unless your medication is a controlled substance. Chang says it’s worth calling back if your insurance company initially declines the refill, especially as the outbreak continues to spread.

As a general rule, Chang says, if you anticipate needing a refill in the next few weeks, it can’t hurt to try to get it now, or to ask your provider for a 90-day supply if you have the option.

Will there be a drug shortage?

We don’t know yet, but the FDA said it’s possible.

“During a drug shortage,” says Nouhavandi, “drugs are either unavailable or prices can rise dramatically. On average, prices increase 2x as fast as expected.

During the H1N1 epidemic, Chen says the US faced a major shortage of Tamiflu, the antiviral medicine used to treat influenza. For the record, Tamiflu doesn’t work against the coronavirus, and neither do any antibiotics. “We don’t know of any medicine that really works for the coronavirus at this point,” says Chen.

That means stockpiling specific drugs will only have implications for the symptoms or illnesses those drugs treat. But Chen says if you’re thinking of filling the fridge, it can’t hurt to have extra supplies in your medicine cabinet as well.

Should “higher-risk” groups do anything extra to prepare?

As with the flu and other respiratory infections, Chang says people with underlying conditions like heart or lung disease may be at heightened risk for severe illness or death. Older people (typically, ages 70 and up) are also a higher-risk population

“For patients with heart or lung conditions like COPD or asthma, it’s important to make sure those illnesses are under good control,” Chang says. Practically, that means patients should talk to their doctors to make sure they understand how to use their medicine correctly, and that they keep enough on hand. 

“Basically, it’s about taking ownership of your own health,” says Chang. “As a physician, I like to be able to fix people, but we really need patients to be active in their own care right now.”

Show Comments (1)
  1. Kayla Anderson

    My father has blood disorder (low Platelets) has to have lab work daily and then visit the physician the next day to see if he needs medication in form of a shot which is regularly needs. He lives in a Extended Living facility which makes the facility nervous letting him go into a clinic and returning. The Extended Living facility has got approval for Health Dept. to do the lab work but the physician which only reviews the lab work and ask my father how is feeling then orders the vaccination. We contacted the physician to allow the Health Dept. nurse administer the vaccination but he says he most see the patient in his office prior to ordering the vaccination? During this crisis limiting my father to exposure which could effect many residents in the Extended Living facility it seem to make more sense to provide this treatment in safest method necessary and avoid exposure for my father and additional residents? This seems no different than teleconference or online with a physician. Concern for my father and other Residents.

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