Routine Healthcare in a Pandemic
During the COVID-19 pandemic, many put off routine healthcare and screenings in order to stay away from the doctor’s office but what are the lasting effects of this delay in healthcare? How are those that delayed their care getting back on track? Plus – what role will telemedicine continue to play in the future of healthcare?
The COVID 19 pandemic has altered life as we know it.
We’ve been forced to miss important things planned vacations, in-person school friends, family gatherings and in some cases, routine health care. We shut down completely for probably a few weeks trying to figure out what we were going to do. This, very disruptive. A lot of care didn’t happen. Not just for me, but for a lot of patients.
The biggest concern we had when we were at the beginning of the pandemic and everything was shutting down was that we were not doing our mammogram screenings. It was a lack of knowledge on how this virus spreads. And that was the more immediate concern, of course, is that, you know, if you have a virus that could kill you in weeks. We’re not worried about getting a screening mammogram or something that may or may not be there.
A lot of people delayed care that wasn’t essential.
So especially around breast cancer screening, colonoscopies. Coming in for well care. Those things really aren’t emergencies.
And people just started to put those items off.
I think nationally we saw a lot of extra deaths from people who did not seek care.
Today, health care is about empowering people to take control of their health, whether creating a fitness routine, choosing the right procedures in medications, or adhering to treatment for a chronic condition. Capital Blue Cross, dedicated to underwriting Transforming Health for the good health of the community.
WellSpan Health. Helping patients reach their health goals through a coordinated system of physicians, hospitals and convenient health care services in communities across central Pennsylvania. Learn more at wellspan.org. WellSpan Health. For the journey that is life.
Support also comes from viewers like you.
Hello and welcome to Transforming Health Routine Health Care in a Pandemic. I’m Keira McGuire.
Over the next half hour, we’ll talk about the challenges we face delivering and receiving care. What we should do now about missed screenings and appointments, how our care may look different in the future. And we’ll talk about the silver linings that have come out of the pandemic.
First, let’s travel back to 2019 to take a look at how COVID 19 disrupted our lives and our health care.
Hi. My name is Matthew Silvis. I’m a family physician at Penn State Health. I’ve been in family medicine and sports medicine now for 14 years, and no one ever would have expected to be in a pandemic such as we’re facing now.
I was really early in my career when we had the H1N1 influenza. This is very different. So I don’t think any of us would have ever guessed would be running medical care through such a time. I take care of full spectrum family medicine patients, newborns to the elderly.
When I first heard about the pandemic, I think I had two major emotions: confusion and fear. We were concerned, obviously, about how best to care for patients who had this new infectious disease that we really didn’t know anything about.
Then we also had this tremendous obligation to take care of people who have chronic medical conditions and how do we continue to provide their care during a pandemic so as to not put them at risk for coming into the hospital or our clinics?
I’d say well over 50% of our patient care we perform in family medicine is directed towards the care of chronic medical conditions. A lot of people delayed care that wasn’t essential. So especially around breast cancer screening, colonoscopies coming in for well care. Those things really aren’t emergencies. And people are just starting to put those items off.
Hi, my name is Chris Sciamanna. I do primary care.
So, a lot of hypertension, a lot of diabetes. But my patients, I have a number of people over 80. So basic primary care for people who are about 65, my average patient.
We shut down completely for probably a few weeks trying to figure out what we were going to do.
It was very disruptive. A lot of care didn’t happen, not just for me, but for a lot of patients.
I think nationally we saw a lot of extra deaths from people who did not seek care.
What we know now at this point in time is that cancer diagnoses dropped significantly last year, meaning that there were many less people that were diagnosed with cancer in the first year of the pandemic. That’s not because all of a sudden our population became healthier. It’s because people weren’t coming to clinical attention to get a cancer diagnosis so they could ultimately enter treatment.
Hi, I’m Dr. Thieme. I’m the director of Breast Care at York Hospital at WellSpan.
What we always tell patients is that one out of eight women in their lifetime will get breast cancer. It’s the second most common cancer for women. So this is extremely common. And as we age, that’s our biggest risk factor.
Most of the cases we catch now are through our screening programs.
So typically a woman who is being told that they have breast cancer never would have felt where this cancer was. It’s so small. It’s not something that they’re going to feel. They’re not going to have any symptoms from it. So that’s the advantage of screenings.
The biggest concern we had when we were at the beginning of the pandemic and everything was shutting down was that we were not doing our mammogram screenings. And it was a lack of knowledge on how this virus spread. And that was the more immediate concern, of course, is that, you know, if you have a virus that could kill you in weeks, we’re not worried about getting a screening mammogram for something that may or may not be there.
There was about two months in the middle of 2020 where we ended all regular mammogram screenings. As the pandemic has gone on and we’ve gotten more knowledge about how that spreads and what we can do to decrease our risk, we started up with our mammogram screenings again. But two months is a significant amount of time to have no screenings going on and try and play catch up from that. It ended up bumping a lot of women into July, into August.
So every year now, I think we’re going to have this surge of women who are now at their annual screenings in July and August. Because they had missed that March, April timeframe in 2020. Once women started coming back for their screenings, we were suddenly seeing a lot of breast cancers that would have been spread out through that time and instead was getting compressed in a shorter amount of time.
The studies that are coming out of last year are showing that we’re seeing cancers at a later stage than we would have otherwise. There’s also patients, fortunately, not in our area, but in other areas where the hospital was getting so overwhelmed that even with a known diagnosis, we were really changing how we would usually treat those patients because we couldn’t get them into the hospital.
So, for example, in breast cancer, they’re medications you can take that slow the growth of breast cancer. In some cases, they were given those medications first and delaying the actual surgery. What we don’t know at this point, and it’s probably going to take years before we know is did that also translate into patients not doing as well ultimately from their cancer? So that is something that is definitely on the minds in the medical profession and will take years to get an answer on.
With a virus that we were still learning about, doctors were forced to find different ways to care for patients practically overnight and are still working to get patients back on track.
Hi, my name is Chris LaCoe. I’m the vice president for virtual care at Penn State Health.
Back in March of 2020, Penn State Health had limited experience in the virtual world. We were very much in the beginning of our journey for virtual care, digital health.
When you think about what we went through 16-18 months ago with, you know, stay-at-home orders, clinics closing, patients being cut off from their providers. Telehealth was the way forward.
I think we learned through the pandemic health emergency that when there was a will there was a way. Within about seven to ten days, we were able to scale our services and we onboarded essentially around 2000 providers and staff members to enable this connection was with our patients and our patient base.
You know, not everybody was living on Zoom in mid-March. We had to build very quickly a way to care for those individuals virtually.
So telehealth wasn’t a big part of our care delivery before the pandemic and we kind of had to build that very quickly. But within a month, we were seeing people remotely. We’ve conducted over 150,000 virtual visits.
Once we had a better sense of coronavirus and how it was spread. We then adjusted our clinical operations across our offices to make it safe for patients to come in to have in-person care, if that’s what they desired.
So we ended up with a blended model where we were able to provide some care via telehealth, while also ultimately coming up with plans and procedures to make in-person care as safe as we could in our clinics. A lot of people did not come into the office or schedule telehealth during the early months of the pandemic. Their priorities were just not to think about health care at that point in time. And even when we reopened to care, we had to spend a lot of time sharing with patients and families, even our staff and providers, how we were going to make those clinical encounters safe.
There was a lot of education that we needed to provide to our patients and families to encourage them to come into the office and to describe all the precautions and safeguards we were putting in place to ensure their safety and reengaging the health care system for their health care needs. But eventually, and you do need to step back into health care and have those screenings performed, and I think that that’s something that not only did we see here at Penn State, but that’s been reported to have been something that’s occurred nationally.
Today, our schedules are full of patients. It looks much more like a pre-pandemic clinic in terms of the balance of what we’re seeing. We’re certainly ordering a lot of screenings that were delayed, especially in 2020. We have had now months to get back up with our patient care needs. So I think screenings in general, it’s taking longer to get to those appointments because we’re still catching up from that backlog.
In some cases, routine screenings are two or three months out, which is a little unusual because we’re playing catch up from when we had to cancel so many of those screenings last year.
We’re trying, especially around breast and colon cancer screening, to get people reengaged. There are cancers that we can actually screen for and diagnose somebody before they’re symptomatic, and that your ability to survive breast and colon cancer screening is much, much higher if your cancer is caught early. And we’ve been really working hard to reengage with our patients to get people back into the system who have delayed or foregone cancer screening in particular.
What this will look like long term, I think, is really hard to say.
You hope that the majority of individuals who had potentially a delayed diagnosis of cancer didn’t delay to the point that they won’t be eligible for effective early treatment of their cancer, which we know is so successful, but I think only time will tell. And I think we still have a long ways to go to reach those patients and get them back into our system to get their cancer screenings.
We can’t help the patients that we don’t know about, so patients need to take that responsibility in making that phone call.
Don’t worry about being late. Just get it done. Don’t worry about being late. Just get it done.
I love that advice.
While the pandemic altered routine health care at home, many of us decided to make changes.
And for some, this came in the form of exercise.
My research focuses on trying to figure out how to design an exercise program that works and that, here’s the hard part, people will do, because that’s really the hard part. So I kind of have this idea that maybe there’s a lower dose that can work for people. So even before the pandemic started, I had approved the protocol that I would ask all my patients to do one 30 second set of push ups, and one 30 second set of squats, every day, going forward.
You got to touch your chest to the ground. You got to extend your elbows so that they’re locked like this. I see a lot of people do this, and that is not a push up.
And the average person did it five days a week, over the first six months, and increased the number of push ups they can do by six and the number of squats they could do by six.
What we found is that people found it easier to walk, you know, a whole bunch of quotes about, you know, people going to the football games at Beaver Stadium and having a lot easier time walking. People who had to visit family members in the hospital. And, you know, you have to walk a lot.
Making walking easier was really one of the things that people commented on the most because a lot of our goal was improving people’s ability to walk, which is the first sign of disability.
Exercise, this powerful drug, if you can put it in a pill, you know it will be a blockbuster. But getting people to do it just has been terribly difficult.
And so we feel like, okay, this might actually really work.
We certainly have seen patients take advantage of the pandemic to really work on health, and I think exercise is a great example of that. So we are really strong advocates for exercise as medicine. The idea that one of the best prescriptions your doctor can give you as a patient is a prescription to exercise.
It’s effective to prevent and treat many, many, many different medical conditions. It’s also been shown that you’re more likely to survive a coronavirus infection and less likely to end up in the hospital if you are a regular exerciser. And I think a lot of people have taken advantage of the past 20-21 months now of this pandemic to really refocus their life and allow exercise to back in.
Hi, my name’s Stephanie Steck.
I’m a physical therapist at a rehab unit. I’ve been doing this for almost 34 years. And I think these last two years have probably been the hardest struggle for me.
I usually work with a lot of neurological patients that’s mostly older people with strokes, Parkinson’s, spinal cord injury, head injury. So they do need a little bit of extra tender care, and they’re scared they’re away from home.
And with COVID also, they’re not allowed to have visitors. So that impacts their wellness as well, that they don’t have the family coming in to provide the support. So staff really needed to step up and provide that extra care for them.
I think one of the hardest things to deal with, with COVID, is not being able to have that personal connection with our patients.
So our faces are now covered, our hands have gloves on them, our clothing is covered with gowns. You’re not shaking hands anymore. You’re not touching like we used to. We can’t use our facial expressions to provide comfort and all they really see is my eyes. So I’ve learned to become very expressive with my eyes, to show comfort, to be empathetic of the things you’re going through that’s been the most difficult thing, is the delivery of care providing the way I used to.
So there’s all these really sick people and they weren’t getting well and in the older population there’s deaths and nursing staff impacted. My coworker’s sick. We were short staffed and we had to work a little harder and with less help. And we all really needed to bind together and help each other out. So that was really hard. I was definitely worried and scared for my coworkers, my family.
There were, it was like almost a year that I really didn’t get to go see my parents because they’re elderly and both have breathing problems, so, you know, kind of drive by with the grandkids and do drive-bys and they’d wave out the window. I kind of had to isolate myself from my family because of COVID, because I would feel awful if I made one of them sick. So that was a really difficult time and I was more fearful, I think, for my family than myself.
I think for me, exercise really helps me work through the stress that I have. It’s a way for me to kind of work out that turmoil in a physical way.
I could still run by myself and I could paddleboard by myself and backpack by myself and hike. So the woods have really been like a solace for me, a place for me to let those feelings out and come out renewed. I think there were some points where I didn’t realize just how stressed I was at work. When I’m done hiking or backpacking, I feel the weight of all that stress off of me.
And I think, Wow, I really needed that. I needed to go do that.
Well, we just got to the trailhead and I’m really excited about being out in the woods today. It was a really long week, and part of what got me through the week was knowing I’d be able to come out here and just unwind and enjoy the peace and quiet of the mountain. I can hear the cars right now, but once we get up into the woods, it’ll be peaceful and quiet. I’m feeling a little tangled up right now. I’m balled up inside so I can’t wait to let the trail unwind how I feel and just find that peaceful moment.
I feel like the first little bit you’re, you know, wearing off the day. And then the second bit, you’re kind of coming into your own mind and your own thoughts. And then by the time I’m done, my mind’s clear.
The anguish or the stress I’ve had is left on the trail and my mind is full of, like, the beautiful things you have.
I like to stand up on these rocks because everything seems so small, makes your problems seem small and insignificant. But when you’re up here, yeah, it inspires me to want to do better and be better and refill my cup so that I can go back into the world and serve my patients and my family and take care of the business I need to.
These moments are really special: top of the mountain.
It’s always been a really important part of my life is exercise, but I definitely feel like it’s ramped up since COVID, that there’s points where my husband will even say, “I think you need to go for a walk in the woods,” because I just come home, you know, real tense and, you know, maybe some terrible things happening on the unit that’s just really hard to take.
So I go out and I go for my walk or my hike or maybe a weekend backpack trip, and I come back and I’m renewed. I’m just really thankful that I can do that.
I love that story of personal change.
While the pandemic has affected the way we deliver and receive care, some say it’s a good thing.
There’s absolutely been some silver linings and some things that in the medical field we really needed to do better on and revisit. We are being much more efficient and how we’re getting patients through.
We’re revisiting how our waiting rooms are set up so that there’s less risk for being in a crowd when you’re waiting for a mammogram. And sometimes having patients wait in their car and sending them a message when we’re ready for them.
So I think in general, it’s actually in some ways improved our flow for some of these screening tests because we know that we don’t want crowds. I think the other thing that’s been a big jump forward in medicine is being able to do telemedicine. And I certainly in my practice had never considered doing telemedicine as part of what I was going to do. But it’s actually been a big improvement for some patients. If they’re post-op and they can’t get into the office and they’re running around to other appointments, I can face-to-face with them over their computer, find out how they’re doing, even look at incisions, and that saves them the trip into the office, and we still have an effective follow up.
I think we proved largely with our providers and staff that for a good number of things, not everything, but for a good number of things. A virtual visit or a virtual encounter with a provider could provide as good, if not better care to patients than would be as in person.
What we’ve heard from physicians or other care providers is that in some instances the quality of the interaction is better.
I think, from the patient perspective, patients like the fact that there’s fewer distractions.
We believe that patients, consumers, are interested in this kind of experience, you know, meeting them where they are.
We believe that’s going to be an important component of our health system strategy moving forward. And we’ll continue to look at other ways that we can apply our virtual telemedicine, digital health solutions to help better care for other patient populations.
Our providers have embraced this in ways that, you know, prior to the pandemic, I didn’t think they ever would have. So it’s been a little bit like riding the tip of a rocket ship, you know, because there are multiple plates spinning multiple things we were doing all at one time.
But yet, you know, for someone who was once a clinician, [it’s] incredibly empowering to be able to contribute, you know, to something like this.
Crisis is opportunity. Every time. And so you have to look at a struggle and say, you know, where’s the opportunity in this?
There must be a chance to think about things differently, to create new habits, look at all the people leaving their jobs. And thinking about work. So I think crisis is opportunity.
I wish it was a shorter crisis, but it did present, I think, an enormous opportunity to think about, to be a little more thoughtful about some things in our lives. I think it’s been a turmoil and turning our world upside down. But if there’s anything good that we can get out of something that’s bad, I think that families that are closer, we all appreciate the things that we have more and maybe we found different ways to deal with life’s upside down moments.
I’d like to thank all of our guests for sharing their stories and expertise.
Please join us next time as we continue to share stories and transform health.
I’m Keira McGuire. Thanks for watching!
Today health care is about empowering people to take control of their health, whether creating a fitness routine, choosing the right procedures in medications or adhering to treatment for a chronic condition. Capital Blue Cross, dedicated to underwriting Transforming Health for the good health of the community.
Wellspan Health. Helping patients reach their health goals through a coordinated system of physicians, hospitals and convenient health care services in communities across central Pennsylvania. Learn more at wellspan.org. WellSpan Health. For the journey that is life.
Support also comes from viewers like you.
Keira McGuire is a health reporter and multimedia producer for WITF. She hosts and produces Transforming Health television programs as well as other shows and documentaries for WITF’s Original Productions. McGuire produced the Emmy Award winning series HealthSmart for the last ten years. Keira previously worked at WBFF in Baltimore and WMDT in Salisbury as a reporter and anchor. She’s a graduate of Towson University.