Primary Care in the Pandemic

| Graceful Health
Moss Linder, M.D.

By Dr. Moss Linder, Grace Cottage Family Health

As everyone knows, things have changed considerably for all of us due to the COVID-19 pandemic. Though there have been related illnesses and deaths in Windham County, we have been incredibly fortunate that it hasn’t been worse. The numbers of cases and deaths have been small compared to other places in the country, so far. Credit is due mostly to our rural lifestyle and the fact that so many in our community have followed the guidelines, maintaining their social distance, washing their hands, and wearing face masks.

The science is clear. The June issue of Proceedings of the National Academy of Sciences reported that airborne transmission is the dominant route for COVID-19 spread. The article further concluded that wearing face masks in public is the most effective way to prevent inter-human transmission, significantly reducing the number of infections. This inexpensive practice, in coordination with extensive testing, quarantine, and contact tracing, is our best means to stop the pandemic prior to the development of a vaccine.

At Grace Cottage Family Health & Hospital, the delivery of healthcare to our patients has changed considerably in response to the virus. While it’s ideal to meet with patients in person, we are fortunate to have had the telephone and virtual media to communicate and to treat our patients. Our most important medical tool is listening to the patient, which we have learned to do very well on the phone or during a Zoom call.

At the beginning of the pandemic, we were almost exclusively employing telephone calls and virtual Zoom for most non-urgent health issues.

During the first month or two of the pandemic, my office become the respiratory clinic, where patients with some sort of respiratory complaint, fever, or other symptoms that might indicate COVID-19 were examined, thus keeping patients who might have the virus separated from others. Now the COVID-19 danger has receded a bit, and some things are opening up. As things have settled, we have opened up the clinic for non-urgent matters. I have my office back, and we are starting to see patients face-to-face.

It’s still different, because all of the providers are wearing masks and eye protection. Patients are screened immediately upon entering the building, asked if they have any COVID-19 symptoms, and their temperature is taken. We only see a limited numbers of patients face-to-face, because we are trying to observe social distancing in our waiting room.

Many patients are still reluctant to come to the hospital or to the clinic office despite our precautions. We understand this, but it’s concerning. When people delay care, their health may deteriorate for non-Covid reasons.

Dhruv Khullar, a physician in New York City, wrote in an article for The New Yorker that, “We tend to follow the virus’s toll narrowly—cases, hospitalizations, deaths—but the damage to public health is also vast, and the longer the pandemic persists, the larger it will grow. Children go unvaccinated; blood pressure is left uncontrolled; cancer survivors miss their checkups. The extent of the collateral damage won’t be known for years, if ever.”

Grace Cottage providers are working to bring in the pediatric population so they stay up-to-date on vital immunizations. Adults also need timely immunizations and have other health maintenance issues that need to be addressed. And we are trying to see patients for wellness exams so they don’t fall behind.

This pandemic affects people with and without chronic health conditions. However, according to the VT Dept. of Health, at least 60% of those with positive tests in Vermont have other medical conditions (multiple chronic diseases), such as diabetes, heart disease, chronic kidney disease, chronic lung disease, and smoking. Of those diagnosed with COVID-19 in Vermont, 25% are current or former smokers. Anyone with an underlying condition, or multiple conditions, is at greater risk for severe illness from COVID, according to the CDC, which adds that, “It is especially important for people at increased risk of severe illness from COVID-19, and those who live with them, to protect themselves from getting COVID-19.”

Although Vermont has had a low number of COVID cases compared to our neighboring states, the statistical trends are similar. For example, older people (over 80) are disproportionately affected. Similarly, Black, Hispanic, and Asian Vermonters have higher rates of infections than White Vermonters. We need to do better as a society so that these racial disparities can be eliminated.

As I started writing this column three weeks ago, I had hoped that the number of cases and deaths would start to dwindle and that we could settle into our “new normal.” With the recent spike in cases in many states, the time for complacency is not now. We have to keep wearing masks, maintaining social distance, quarantining appropriately, doing contact tracing, and washing our hands.

At Grace Cottage, we believe we can still see patients safely face-to-face and have them get labs and imaging tests as needed. We’re doing our very best to do this safely, for our patients and for ourselves. We remain vigilant and prepared.

Dr. Moss Linder joined the Grace Cottage Hospital staff in 1997. He received his medical degree from the University of Vermont in 1991 and completed his Family Medicine residency at Oregon Health Services University. Prior to Grace Cottage, he worked as a family physician at the Acoma Cañoncito Laguna Hospital in New Mexico.