Preventive Health Suffers Under COVID
Marge Freundl, MSN, RN
ANA-Michigan Nursing Practice Committee Member
In this “new normal” of staying home, staying away, and social distancing, emerging data has shown an impact on preventive health for adults and children. Mehrotra, Chernew & Linetsky, et al (July 2020) reported earlier this year that the COVID-19 pandemic has “dramatically changed how outpatient care is delivered”. Initially, providers deferred elective and preventive health visits, and converted inperson visits to telemedicine. Many patients avoided visits because of fear of leaving their homes and risking exposure. The authors reported that by April, the number of visits to ambulatory care practices declined by nearly 60 percent, with a rebound in May; but the number of visits plateaued, and were still roughly one-third lower than what was seen before the pandemic. Of noted concern was that the rebound was less evident for children visits.
Wagle, Isakadze &, Eatz, et al (July 2020) discussed the impact of comorbid diseases, including CVD, diabetes, or hypertension, on COVID-19 clinical outcomes. They note early discussions concerning ACE-Inhibitors may have caused some patients to stop these medications, despite their known advantage to hypertension and heart failure management. Admissions for acute coronary syndromes, decompensated heart failure, stroke, and ST-segment elevation myocardial infarction catheter lab activations were all decreased. Unique challenges were also reported in maintaining rapport through video clinic visits, cardiac rehabilitation opportunities, and medication availability and ensuring care for patients without technologic access.
Martin, Kurowski & Given, et al (Sept 2020) reported on a large study sample of health claims clearinghouse records from 18 states containing 184 million claims from 30 million patients in 2019 and 94 million claims from 20 million patients for the first 6 months in 2020. They examined women's preventative health services, select services provided during pregnancy and delivery, childhood immunizations, and other sentinel preventive medical services including colonoscopies, and prostate-specific antigen (PSA) tests. Overall, they found that the pandemic has significantly decreased use of certain health care services: childhood immunizations (down about 60 percent in mid-April in 2020 compared to 2019), mammograms and Pap smears (down nearly 80 percent in April 2020 compared to 2019, and by June were down nearly a quarter from 2019), Colonoscopies decreased almost 90% at one point in mid-April 2020 but as of June rebounded to about 30% compared to 2019). PSA tests for prostate cancer screening, decreased approximately 22% then rebounded,, with delivery of PSA tests reaching near 2019 levels starting in June. The Centers for Disease Control (2020) has stated: “ensuring immunization services are maintained or reinitiated is essential for protecting individuals and communities from vaccine-preventable diseases and outbreaks and reducing the burden of respiratory illness during the upcoming influenza season.
Each of these studies presents missed opportunities in the provision of preventive health. As nurses, we work in a variety of settings and live in communities that need to be informed about the importance of preventive health during these “challenging times”. Consider ways that you can help in this effort: post something on social media, write a short article for a community or church publication, talk with patients and families (including your own!) at discharge from care about resuming preventive health activities with their providers and other resources. And, take care of yourself during this time of stress...remember to have an annual health check up, get your mammogram, colonoscopy, flu shot and other important vaccines!
Anjali Wagle, MD ; Nino Isakadze, MD ; Tiffany Eatz, BS ; Roger S. Blumenthal, MD, FACC ; Seth Shay Martin, MD, MHS, FACC (July 13, 2020). Continuing Preventive Care During the COVID-19 Pandemic: Discussion of Recent ASPC Recommendations. American College of Cardiology: https://www.acc.org/latest-in-cardiology/articles/2020/07/13/08/24/continuing-preventive-care-during-the-covid-19-pandemic
Katie Martin, Daniel Kurowski, Phillip Given, Kevin Kennedy, Elianna Clayton (Sept 2020). The Impact of COVID-19 on the Use of Preventive Health Care. The Healthcare Cost Institute: https://healthcostinstitute.org/hcci-research/the-impact-of-covid-19-on-the-use-of-preventive-health-care
Centers for Disease Control (June 9, 2020 ). Vaccination Guidance During a Pandemic. https://www.cdc.gov/vaccines/pandemic-guidance/index.html