Among the consequences of the pandemic is that many Americans have fallen sorely behind in preventive care, with underserved groups disproportionately impacted. Now that hospitals and doctors’ offices are open for business and have strict safety protocols in place, providers are urging patients to get caught up on essential tests and procedures that can prevent serious complications or even death.
A survey by the Centers for Disease control and Prevention (CDC) done in June, 2020
found that “an estimated 40.9% of U.S. adults have avoided medical care during the pandemic because of concerns about COVID-19, including 12.0% who avoided urgent or emergency care and 31.5% who avoided routine care.”
This data points alone to a disturbing trend: patients are missing out on essential care that could minimize complications and ensure better outcomes. Worse, the same groups who have already experienced greater impacts from COVID-19 are more likely to have conditions like hypertension and diabetes that could lead to serious consequences if undetected or untreated. These groups are also less likely to have timely and affordable access to preventive care. Health professionals at MidMichigan Medical Center – Mt. Pleasant say this worrying trend has continued into this year, and it’s a cause for concern.
“We're seeing quite a few people just not come in for their wellness exams, not come in for management of some of their chronic illnesses, and trying to hold off,” says Lena Widman, D.O., family physician at MidMichigan Health. “Unfortunately, that has led to some people's diabetes getting worse, some people's cholesterol getting worse… I had another patient who was recently diagnosed with breast cancer. It wasn't seen on her mammogram two years ago, she skipped it last year, and it’s hard to say if it was something we could have seen last year.”
Over the last year in particular, the regular lifestyle habits of many people have changed – sometimes in ways that aren’t necessarily healthy. Talking about those changes during an exam can provide the opportunity to analyze those lifestyle habits. Even for those without a chronic disease who are young and feel healthy, Dr. Widman says seeing the doctor every year for a physical is a crucial part of staying healthy in the long-term.
For more information about recommendations for essential care, visit midmichigan.org/about/news/2021/closing-gaps-in-essential-care.
“We're seeing more and more now in young people that they're having increased blood pressure at an earlier age. Sometimes in certain patients, depending on their family history, it may be appropriate to screen for diabetes, screen for high cholesterol, and talk about healthy lifestyle habits including nutritional aspects, exercise, making sure they're up to date on their immunizations – not just the COVID vaccine, but there's other vaccines that are important to make sure that we're up to date on to protect ourselves and to protect our community as well,” Dr. Widman says.
She adds that other critical screenings, depending on someone’s age, include a Pap Smear to screen for cervical cancer, a mammogram to screen for breast cancer, a colonoscopy to screen for colon cancer, and various bloodwork to screen for other health conditions.
Adults haven’t been the only ones falling behind on their regular health exams and screenings over the course of the past year, though.
According to the Health Care Cost Institute, “In 2020, childhood immunizations declined about 18% for the year compared to 2019.”
“Especially throughout the COVID pandemic there's actually been an increasing number of kids who are not vaccinated on schedule, and that's actually decreasing the percentage of overall vaccinated people in the communities, which is what leads to outbreaks of various diseases,” says Shreya Wachob, D.O., pediatric physician at MidMichigan Health.
Dr. Wachob says the measles outbreaks are one such example. According to the CDC
, during the 2019 measles outbreak in the United States, 1,249 cases were reported from January to September of 2019 (the highest annual number since 1992). Of those cases, 89% were unvaccinated or had an unknown vaccination record.
If children are behind on their vaccinations, Dr. Wachob says it’s important to start catching them up sooner rather than later. Even if kids are being homeschooled or doing virtual learning, she says getting vaccinated on time is important because they still interact with other people at some point – at the library, grocery store, beach, or a play-date.
However, getting kids up-to-date on their vaccinations isn’t Dr. Wachob’s only concern. She says well-child visits screen for a variety of other conditions and ensure children are progressing in their growth as they should be.
“I would say the biggest one we do is we check their weight and their height, make sure they're growing appropriately and then we also screen for depression and anxiety,” she says. “For my younger kids, making sure we're doing those routine checkups is important to make sure developmentally they're doing everything they should be. And then for the older kids, it's actually really important right now -social interactions are so important and a lot of kids are homeschooled, are virtual schooling, are not going out and seeing their friends and interacting with people like they would normally - so we are seeing an increase in depression in a lot of our older adolescents and adults in general.”
Shreya Wachob, D.O., pediatric physician at MidMichigan Health.
With children suffering from depression, Dr. Wachob says the parents usually have an idea that something is going on but may not know the extent of it. The well-child visits provide an opportunity for the doctor and parents to get on the same page about the child’s health.
“Sometimes the questions that we ask in the office are phrased in such a way that the kids wouldn't necessarily volunteer that information but when they're directly asked about it they do tell you an honest and open answer,” she says.
For both adults and children alike, seeing the doctor again for a regular exam or screening is easy, says Jennifer Ebnit, director of operations for MidMichigan Medical Center – Mt. Pleasant.
The first step is to just call and make the appointment. Ebnit says the process for scheduling and attending an appointment is much the same as prior to the pandemic; however, you will be asked COVID-19 screening questions a couple of times and will have to follow other COVID-19 safety precautions.
“If you're kind of anxious about being exposed to anything when you come in, even though that risk is really pretty low, you could ask when the slower times of the day are or when the best time would be to come in and not encounter too many people,” says Ebnit.
Additionally, those who need lab work done can schedule an appointment online if they wish so they can limit their time in the building and minimize their potential for exposure. 24/7 services are also available for lab and imaging.
She adds that while MidMichigan Medical Center – Mt. Pleasant has worked hard to keep healthcare available throughout COVID-19 by offering televisits, certain things – such as lab work, annual screenings, and vaccinations - do need to be done in-person.
Lena Widman, D.O., family physician at MidMichigan Health.
“Televisits were made available for people during the time that we really were trying to stay in compliance with the order to stay at home and avoid outside contact,” says Ebnit. “They are a really good option for many conditions, but there are some conditions that really do require more of a physical exam.”
In order to keep patients safe when they come for those in-person visits, Ebnit says MidMichigan Medical Center – Mt. Pleasant has been hyper-diligent throughout the pandemic and continues that mission – from mask-wearing to social distancing to screenings for all who enter to hand sanitizer through the building, and everything in between.
“By and large, people who have come in have felt very safe. It is our top priority,” she says. “Not only are we trying to keep ourselves safe – we want to be safe for our families that we go home to every day – but we absolutely want our patients to feel like getting their health care is a priority that they can still access during this time.”
Not only is health care something that patients can safely access during this time, but something medical professionals say is critical for them to access.
“Even though COVID is out there, other illnesses still exist,” says Dr. Widman. “Chronic disease is still there. It's still important to get your preventative measures because people are still getting cancer. People are still getting diabetes, high blood pressure, high cholesterol. So, it's important that we're able to screen for these and care for these, even though we're very aware of COVID and we're very careful to make sure we're not increasing the spread of COVID.”