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Life After Shelter In Place: Part I

As COVID-19 restrictions begin to lift, Dean Lloyd Minor discusses the importance of safely re-engaging patients in preventive care.

Nine weeks ago, Bay Area officials first ordered residents to stay at home to help prevent the spread of COVID-19. We are starting to see signs that these actions are working. Locally and across the country, COVID-19 cases are flattening in areas that were once hotspots, prompting public health officials to begin loosening restrictions. The question now is: where do we go from here?

In this two-part series, I attempt to answer that question, outlining some of the most critical issues that we, as a society, must address to achieve a better status quo in the weeks and months ahead.

Without a doubt, COVID-19 has transformed our lives, our communities and our economy. Extraordinary steps, including shelter-in-place (SIP) orders, were necessary to prevent the virus from overrunning our nation's health care system. SIP has helped to avoid that worst-case scenario, but as a long-term strategy, we know we cannot stay at home forever.

Going forward, we will need a nuanced and targeted strategy that enables us to resume vital aspects of public life while mitigating the risk of future outbreaks.  

Preventive Care Is Still Essential Care

As we consider that future, one of our top priorities must be restoring preventive care. As a physician and long-time advocate of Precision Health, I am growing concerned about the health of patients not infected with COVID-19, as trends continue to suggest their reluctance to come back for essential care:

  • According to the EPIC Health Research Network, preventive screening rates across the United States declined in March by up to 94% for cervix, colon and breast cancers when compared to average volumes over the past three years.
  • The New York Times recently reported that vaccinations for measles, mumps and rubella nationally dropped by 50% during a week in early April, compared to a pre-coronavirus baseline in February.

We should not assume that these numbers will fully rebound without intervention. As recently as April, national polls found that a large percentage of patients were worried about visiting their doctor for fear of being exposed to COVID-19. Unless we can allay these fears, we may soon be contending with an equally severe health crisis -- if vaccination levels drop and patients seek care only when their conditions become life-threatening. We have the power to prevent this outcome.

The first step is acknowledging people's concerns, and that starts with communication. As health care providers, now more than ever, we must engage our communities to rebuild trust. We will need to show our patients the precautions we have taken to safely resume care -- through grassroots outreach, patient portals, media interviews, social media and other channels. We must also work in partnership with associations and advocacy groups to reach our most vulnerable populations -- including the one in two Americans living with a chronic condition -- urging them not to delay care when they need it.

However, that only takes us so far. Only when people see restrictions lift around them without subsequent outbreaks will they truly feel safe. To accelerate that future, we will need a comprehensive, national solution that enables us to achieve a "new normal" until a vaccine is broadly available.

In Part II of this series, I describe the key elements that must be in place for society to recover, restore and reopen safely.

Lloyd Minor, MD, is dean of the Stanford School of Medicine and a professor of otolaryngology-head and neck surgery. This piece originally appeared on his LinkedIn page

Photo courtesy of Stanford Health Care

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