Is now the time to go for an annual physical exam or health screening?

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A syringe with an influenza vaccine inside heads to its mark during a flu vaccination at Eastfield College in Mesquite, Texas, Thursday, Jan. 23, 2020. (LM Otero/AP Photo)

A syringe with an influenza vaccine inside heads to its mark during a flu vaccination at Eastfield College in Mesquite, Texas, Thursday, Jan. 23, 2020. (LM Otero/AP Photo)

Are you on the front lines of the coronavirus? Help us report on the pandemic.

Hospitals and clinics are open now for routine, preventative care that was postponed in the early days of the coronavirus pandemic. But still some people wonder: Is it safe to go?

Michael LeVasseur, a visiting assistant professor of epidemiology and biostatistics at Drexel University, said a lot of his friends and family members have been asking him that question, along with others about the pandemic. So many questions, that he put together two YouTube videos to try and address them at once.

LeVasseur’s advice is to contact your doctor, but said he’s confident that physicians who are accepting patients will be cleaning their offices regularly and taking other precautions.

“People are really looking for answers to very specific questions, and it’s hard because everyone has very different personal circumstances and not everyone understands all of the nitty-gritty transmission dynamics,” he said. “It becomes unmanageable when I’m getting 50 messages from people in a day … but I’m happy to do it from time to time.”

When preparing for a trip to the doctor’s office, there are some questions people can consider while also trying to prevent the spread of COVID-19, said LeVasseur and other experts.

Neal Goldstein at Drexel University and Aimee Palumbo at Temple University, both epidemiologists, said those questions include:

  • Do the staff and patients wear masks at all times?
  • Do the staff have enough masks and protective equipment?
  • Will there be a limit on how many people can be in a waiting room?
  • Are the staff being tested for COVID-19?
  • How often are staff cleaning the waiting rooms and offices?
  • If you don’t drive, can you take public transit while keeping your distance from other people and washing your hands before and afterward?

The places opening back up for elective and routine medical appointments all highlight the precautions they are taking, as well as other measures such as screening patients days before an appointment, temperature checks and COVID-19 tests for patients who stay at their hospitals.

“For these routine checkups, it’s easy: The people that are at highest risk of COVID or poor outcomes from COVID are also the ones that … are going to benefit the most also from these routine procedures, so we have to recognize that these things still do need to happen,” Palumbo said. “It’s better to treat something sooner than later, so it is still important to continue their care even while this is going on.”

Neil Fishman, an infectious disease specialist and chief medical officer at the Hospital of the University of Pennsylvania, said that, broadly speaking, fewer patients have been coming in with routine medical problems. That worries him.

“We know COVID-19 did not cure cancer, COVID-19 did not cure heart disease, so that means that there are a lot of people who have been afraid to get routine health care either for existing conditions or for … as-yet-undiagnosed conditions,” he said. “It’s critical for people to get their annual physical exam, to get gynecologic checkups, to get mammograms, and colonoscopies, and particularly flu shots during cold and flu season.”

“We have seen what a world without vaccines looks like,” he said. “It looks like this pandemic that we’re experiencing, and it would be even more devastating if we saw a recurrence of vaccine-preventable illnesses because people are avoiding health care out of fear.”

Some of that has already happened. A report from the Centers for Disease Control and Prevention last week showed a drop in vaccinations among children age 2 or younger in Michigan during the pandemic compared to similar periods in the past few years.

“The observed declines in vaccination coverage might leave young children and communities vulnerable to vaccine-preventable diseases such as measles,” the authors wrote. “If measles vaccination coverage of 90%–95% (the level needed to establish herd immunity) is not achieved, measles outbreaks can occur.”

At the same time, it can be difficult to talk to patients about coming back for routine appointments. In an editorial in JAMA: Internal Medicine, a medical journal, David Asch, a professor of medicine and health policy at the University of Pennsylvania, wrote that “the biggest challenge in helping patients feel safe is doing so in a way that is not itself scary.”

“Hospitals should pay attention to how they may be perceived to ensure that they do not inadvertently scare away the patients who need them,” Asch wrote.

Fishman at Penn Medicine agreed. He said he now frequently tells patients who ask that going to the grocery store is riskier than a routine visit to a doctor’s office.

“People are anxious when they’re visiting physicians or other health care providers; the anxiety is going to be ever more increased by the changes that COVID-19 are mandating now,” he said. “I always try to think about how a patient would feel, how my mother 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, indeed, talked to his mother, who has a chronic illness, about whether she should go to her routine follow-up visits after being hospitalized at the beginning of the pandemic. He said she goes to those appointments, but he does the grocery shopping for her.

There are some procedures that might be done virtually or just postponed. Jeffrey Jahre, an infectious disease specialist at St. Luke’s University Health Network in Bethlehem and senior vice president of medical and academic affairs, said physical therapists at St. Luke’s have been seeing a lot more patients virtually.

The American Physical Therapy Association put out general guidelines for their members this month, suggesting virtual visits for patients at risk of getting severely ill from a COVID-19 infection, who are concerned about an inpatient visit, or if the alternative to a virtual visit is no care at all.

Dentists are open, but they are not doing any cosmetic procedures right now, like veneers, a procedure that involves using a shell to correct stained or chipped teeth, said David Tecosky, a dentist in Philadelphia.

He said he has to catch up with a backlog of two and half months worth of appointments, but is seeing his patients for all other procedures, including checkups and certainly emergency procedures like treating infections, or cracked teeth that could lead to pain and problems with eating. He said he would recommend patients call their dentists, because preventative care is much better than treatment.

Also, a dentist might see 10 patients a day before the pandemic, but Tecosky said that cannot happen now with the various social distancing measures, and the need to change gowns and other personal protective equipment between patients. For example, he said he is now wearing hairnets, which he wasn’t doing before the pandemic.

He added his practice also has new measures to protect staff and patients, such as plastic screens at the front desk, distance between people in the waiting room, and curtains in the operating area. The CDC has more detailed guidance for how dentists should be operating.

Tecosky said that his whole team has been answering phones, including himself, and patients have not been reluctant to come back for appointments.

“Even though dentistry is not known to be a place that people flock to go to because they love to, we are finding that patients are not canceling appointments or not saying, ‘oh I don’t want to come in or wait six months’ or ‘I’m going to wait till this all passes.’”

However, he said he expects lasting changes to how dentists practice. For one thing, masks that used to cost $10 now cost $30. He had to furlough almost his entire team of 6-7 because they could provide only urgent care at the start of the pandemic. They are all back now, but are only getting around 20 percent of the money coming in compared to pre-pandemic levels, far below the amount needed to cover overhead costs. He said dentists will keep trying to figure out ways to get people the care they need, but it could mean dentists have to charge more in the future.

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