Like so many hikers who climb to a mountain’s peak, I feel a sense of both joy and accomplishment, especially when I can look down into the valley, see the twists and turns on the path, and remember the ascent.
Epidemiologists and public health experts predict (and hospital data support) that here in Massachusetts, we are now at the peak of the COVID-19 pandemic. And though we are increasingly recognizing that the COVID-19 peak is, unfortunately, a long plateau, we can at least take this moment to see just how far we have come on this journey.
Over the past seven weeks, hospitals in Boston have been busily building up clinical and physical infrastructure, training staff, accelerating testing capacity, and creating new clinical guidelines. At Boston Medical Center, we have gained 23 more ICU beds, have converted pediatric wards into adult wards, reclaimed a building to isolate COVID-19 positive individuals who are homeless, created algorithms for allocation of ventilators in the unthinkable event that there is a shortage, and built an extender team of palliative care physicians, social workers, and chaplains to be available to patients and families in guiding heartbreaking end-of-life decisions. We have borne witness to patients recovering from COVID-19 despite the odds and now even play a theme song, Journey’s “Don’t Stop Believin,’” for them when they leave the hospital and we weep with joy.
But in the distant skyline, there is something looming that not many people are yet discussing: a second peak. This second peak will likely come with a combination of more COVID-19 patients, a seasonal influx of flu carriers and — importantly — people with other maladies who are now delaying care in dangerous and worrisome ways but will come rushing into our clinics and hospitals once the COVID-19 pandemic appears to be easing.
As the weeks have marched on, the patients who normally would have filled our hospital beds for acute illnesses such as congestive heart failure, acute kidney disease, and strokes are at record low numbers. People who have important cancer treatments to attend are often not showing up. Primary care, despite now being done in the comfort of one’s own home with telemedicine, is also less busy. Fewer people are scheduling check-ins with their primary care providers to review their chronic conditions such as diabetes, hypertension, or depression. Where did all of these non-COVID-19 people go?
When I reach out to my patients, many share that they are afraid to come in for important lab work, imaging, or even to the emergency room for worrisome symptoms. The pictures of those of us on the front lines in hospitals with masks, shields, and gowns are frightening, and the stories of COVID-19 illness are terrifying. Many of our fellow Bostonians are also working hard to hold onto their homes and their dwindling incomes, keep their children safe and fed, and are buried by their increased anxiety and depression. These are difficult times and, as health care providers, policy makers, and community members, we must begin now to plan how to climb this second peak.
One important place to begin is at the primary care level. With massively plummeting revenues, many primary care clinics have had to reduce their staffs significantly, and some have even had to close their doors. There are estimates of up to 60,000 primary care practices in the United States having to permanently close or significantly cut staff as a result of COVID-19, even accounting for the essential federal assistance package.
In Massachusetts, this means that it is more important than ever for policy makers and government officials to increase investment in primary care. This increased investment could be used to help health care workers be nimble in how they will care for this onslaught of patients — deploying more community health workers, doing more population health outreach, and collaborating and building with their behavioral health colleagues to care for the mental health consequences of this pandemic.
Telemedicine — an innovation that finally took off as a result of this crisis — must stay. This means continuing full insurance coverage and reimbursement for telemedicine so that health care providers can take care of larger swaths of people in the comfort of the patient’s home and together we can slowly get people back on track. Telemedicine has been a key support in keeping people safe during COVID-19, but it will also be a critical building block in the health of populations in the future.
Finally, we cannot wait for COVID-19 to be “over” to begin climbing this second peak. We should start now by reminding people that if they are sick, they must come in to be seen. We have protective equipment, there is space for them in the emergency rooms. If people have chronic conditions, they should reach out to their primary care provider to check in, get refills, and make a plan on how to keep healthy. We are here and ready to take care of them.
We cannot wait. We must do this together. Let’s begin to climb that second peak.
Dr. Katherine Gergen Barnett is the vice chair of Primary Care Innovation and Transformation and residency director in the Department of Family Medicine at Boston Medical Center and Boston University Medical School.