13 minute read
Post-pandemic healthcare
By Elizabeth Morse Read
We’ve all just emerged from fifteen months of enforced hibernation, an incredibly stressful period of isolation, lockdowns, and serious disruptions of everyday routines, leaving people cut off from family, friends, and familiar faces. Many people were so afraid of catching the Covid-19 virus by going to a doctor’s office, urgent care center, or hospital that they waited until they were literally dying before they would seek medical help. It will take years to recover from that sudden gap in medical care, both personal and institutional.
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Sixty percent of Americans have at least one chronic disease, and 25% have two or more, all of which require regular monitoring. So delayed health care during the pandemic has resulted in worsening chronic diseases and missed opportunities for early detection of new diseases. During the worst months of the pandemic, many Americans ignored or just endured warning symptoms of serious disease – chest pain, severe headaches, numbness – all because they were terrified of catching Covid-19 in a doctor’s waiting room. As a result, deaths caused by chronic conditions like heart disease, stroke and diabetes increased, even though visits to the emergency rooms for those conditions were noticeably down. According to the Centers for Disease Control and Prevention (CDC), by June of last year, emergency room visits for heart attacks had dropped 23%; for strokes, 20%; and for uncontrolled high blood sugar, 10%. A study published in the Journal of the American Medical Association reported that the states hit hardest by Covid-19 deaths in March and April 2020 (e.g., Massachusetts and New York) also reported a huge spike in deaths caused by chronic
NOT JUST FOR GLASSES ANYMORE
Most people think that going to the eye doctor is just for getting a new prescription for glasses or contact lenses. However, if you have any chronic medical condition or you wear glasses or contact lenses, you need to schedule an annual appointment with an eye doctor. Regular dilated eye exams with an ophthalmologist (not an optician or a work/ school nurse) are not just a test for visual acuity – eye exams not only detect early signs of eye-related health problems like glaucoma or cataracts, but can also detect early symptoms of non-vision-related disorders like high blood pressure, Alzheimer’s disease, arteriosclerosis, diabetes, metastatic cancer, herpes, lupus, and even Crohn’s disease. They provide the eye doctor with a window into your overall health, not just your vision.
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diseases like diabetes, heart disease, and Alzheimer’s. New York City alone, the epicenter of the pandemic in the US, saw an almost 400% increase in heart disease deaths and a more than 350% increase in diabetes-related deaths compared to the same time period a year earlier.
The dangers of delayed medical care
When the Covid-19 public health crisis was declared in mid-March of 2020, preventive health care visits, tests, procedures, and non-emergency surgeries were abruptly put on hold. At-risk people skipped comprehensive eye exams [see sidebar], visits to the podiatrist, dental cleanings, prenatal exams, blood pressure checks as well as crucial blood and urine tests. By mid-April 2020, vaccinations had dropped by nearly 60%, mammograms fell by 77%, and colonoscopies declined by 88%. And although these numbers have slowly improved over time, the long-term effects of delayed health care will ripple outward for years to come. Primary care doctors, pediatricians, dentists, and mental health care practitioners saw their practices turned upside down by a tsunami of cancelled appointments and the chaos of developing alternative telehealth procedures. Hospitals were so overwhelmed with treating Covid patients that they performed only life-or-death/ emergency surgeries, indefinitely postponing any surgery or procedure deemed to be “elective.” This resulted in deteriorating quality of life for people suffering from painful or disfiguring – but not life-threatening – medical conditions (e.g., endometriosis, arthritis, burn scars), and an increase in patients showing more advanced chronic diseases and disorders that had not been managed at an earlier stage.
The ultimate “cabin fever”
When the country went into lockdown last year, many Americans either lost their jobs or suddenly had to work from home. Schools and day-care centers closed, so many parents had to homeschool their children, all while worrying about the welfare of their elderly relatives. Everyone was stressed to the max, binge-watching TV, binge-eating unhealthy foods, binge-shopping online, and unable to play outdoors or exercise at the gym. People drank too much, smoked too much, and took out their frustrations and anxiety on other family members, like mice in an overcrowded cage. In one survey of primary care providers last year, 31% found increased addictions among their patients, and 37% reported noticeable deterioration in patients with chronic health conditions like diabetes, heart disease, high blood pressure, and obesity. So, when people started going back to their dentists and primary care doctors this year, they presented with increased tooth decay and gum disease, as well as complaints of neck and back pain due to sitting too much or from using a bed, kitchen counter, or couch as a workstation.
PUT YOUR BEST FEET FORWARD
Nothing can ruin your day faster than foot pain, whether it’s caused by an injury or a broken bone, by poorly-fit shoes, or by an assortment of ailments like corns, bunions, ingrown toenails, plantar warts, or fungal infections. Athletes (especially runners), people who are literally “on their feet” all day, and anyone suffering from diabetes, vascular disease, or neuropathy (tingling or numbness) needs to schedule regular visits with a podiatrist. Podiatrists can perform minor procedures in the office, prescribe medications, fit you for corrective shoes or inserts and even schedule you for surgery at a nearby hospital.
The shadow epidemic
In that 2020 survey of primary care providers, more than 80% also reported worsening mental health among their patients, including a spike in domestic violence and child abuse/neglect. According to the Centers for Medicare and Medicaid Services (CMS), patient
the region’s coastal charms. Their new When asked her favorite part of the Book Fair, property was a former tomato farm, per-Baker-Smith replies, “The fifteen minutes the chilvisits to doctors and health care clinics fect for supporting the couple’s new hob dren get to pick out books before the opening have gradually started to rebound, but by: raising chickens. whistle.” (The official start of the Book Fair begins mental health services have been slow to bounce back to pre-pandemic levels. Unfortunately, this coincided with a crisis nationwide in mental health problems brought on by the anxiety, stress, isolation, and the overall upheaval caused by the pandemic. In particular, those who were in treatment or recovery from substance abuse were suddenly left out in the cold, resulting in an increase in drug-related deaths. Calls to domestic abuse hotlines increased by almost Fortunately for them, they had a knack for it. Before too long, the Bishops had more eggs than they knew what to do with. They began selling the surplus, and learning about how to expand the farm in a healthy and sustainable way. To give a sense of how successful this expansion has been, the farm’s chicken population has ballooned from the original 20 to over 3000. While her husband has kept his IT job, Ester has been able to commit herself to the farm full-time. She prides herself on at 11 a.m. but children are allowed into the book tent at 10:45 for exclusive browsing time.) “It’s wonderful to watch children being fascinated by books,” continues Baker-Smith, “going down the rabbit hole of a story, and sitting down on the grass to read in an age where everyone is looking at screens.” After so many decades, it is understandable that many stories surround the Westport Friends Book Fair. It is rumored that, in the early years, one book-browser discovered a first edition of Moby Dick which he bought for fifty-cents. The next year 10% and telehealth counseling surged providing her animals with joyful, stresshe sheepishly returned to make a donation to the 2,700% between March and October free lives. “People should know where Westport Friends telling them he sold the book for 2020, but still did not offset the decline their food comes from – you can really “a lot of money.” in pre-pandemic mental health service taste the difference,” said Bishop. The Book Fair is also full of traditions, including appointments. the honorary “Blowing of the Whistle” to signal the In addition, with schools and day-care Green acres official opening of the book sale. centers closed, the number of emergency Bishop’s commitment to “beyond or“It is a great honor to be chosen,” says Greg room visits related to child abuse/neglect ganic” farming extends beyond cuddles Marsello, citing this as his favorite part of the Fair. decreased by more than 50% during and words of affirmation to her livestock.For Gretchen Baker-Smith, the annual night-bethe pandemic compared to 2019 – but She ensures all the animals are provided fore-book-sale “Chopping of the Tabbouleh” is one the percentage of such visits resulting with healthy, organic meals, and that their of her fondest traditions. The tabbouleh, a type of in hospitalization increased. The loss of waste is repurposed as manure. Lebanese salad, is sold to the public in a flatbread social supports greatly heightened the “You can see how green the grass is wrap every year on opening day (along with other risk of child abuse and neglect, especially where the turkeys have been,” Bishop light luncheon items, beverages and snacks). as children lost contact with “mandated says. “That’s because they fertilize the “It takes a small army of people to chop the salad reporters” (teachers, doctors, and social soil with their manure. Manure is the every year,” says Baker-Smith. “But people have workers) who would have intervened. basis of organic fertilizers. There are no come to expect it.” over the years, many customers On the road to recovery Start your post-pandemic recovery by scheduling a comprehensive physical exam with your primary care health provider ASAP. Bring up any new health concerns, both physical and emotional, that developed while you were avoiding contact with medical facilities last year, like headaches, weight gain, or anxiety. Follow through on your doctor’s recommendations for diagnostic tests, chemicals added, or needed, when the animals do their job.” Speaking of animals doing their jobs, Bishop has conscripted her goats and pigs into clearing away swaths of underbrush on the property – the “gnarly vines” that give the farm its name. Gnarly Vines coordinates with neighboring farms to provide its customers with a variety of sustainable and organic products. Angus beef, for instance, will sell out almost as soon as it comes into have expressed their relief to Baker-Smith, saying “I was so afraid [the tabbouleh] wouldn’t be here.” “Probably my favorite part of the Annual Book Fair,” says Deanna Chase, “is Saturday evening after the huge, long day” (volunteers arrive about 7 a.m. to help set up) “when we finally have time to just sit under the tent and reflect back on the day, relaxing with friends.” The Fifty-Fourth Westport Friends’ Book Fair officially opens at 11 a.m. on July 11, rain or shine. The sale will continue through Sunday, July 19 and will immunizations, cancer screening stock. be open from “dawn to dusk.” procedures, and consultations with other But the farm is not bound by terrestrial The six-for-a-dollar paperback books may be purmedical specialists. And re-establish your limitations: the Bishops have partnered chased starting at 10 a.m. on the opening day and pre-pandemic appointments with other with Captain’s Finest and Sakonnet the children’s book section opens exclusively for health care providers – your dentist, physi-Lobster to bring fresh seafood to market. kids at 10:45 a.m. Book prices range from one dolcal therapist, ophthalmologist, podiatrist Bishop is particularly proud of a new ini-lar to five dollars a book, with the average cost be[see sidebar], mental health counselor, or tiative at the farm: food security commu-ing $1.50. Light lunch, snacks, and beverages will dermatologist. Telehealth consultations nity supported agriculture (CSA) plans. be sold on the opening day of the sale. will still be available post-pandemic with CSAs, popular among farms nation-If you haven’t yet experienced this celebration some providers, but there’s no substitute wide, allow customers to pre-purchase of books and community, you need to. Bring for in-person, face-to-face medical exams “shares” of the farm’s produce, which are your family to the Westport Friends Book Fair and and tests. start your own summer tradition. you won’t be disappointed. CONTINUED ON NEXT PAGE
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