Preventative Medicine: Front-Line Care for All

One ripple effect in the vast wave of change brought about by COVID-19 may be evident in public perception regarding appointments for routine healthcare. Peter Aran, M.D., associate dean for clinical affairs, chief medical officer, OU Physicians-Tulsa, sees a number of positives worthy of emphasis during a time marked by fear, possibly driven by misinformation.

Peter Aran, M.D.

Dr. Aran said healthcare professionals worry that irrational fear has become an invisible barrier, discouraging people from keeping appointments for routine care. In some cases, even urgent-care needs are not being addressed. A recent report indicates a staggering drop in routine childhood vaccinations, as much as 30%, which occurred nationally between mid-March and mid-April. Avoiding exposure to COVID-19 is likely the reason parents weren’t taking their children, or themselves, to see their doctors. In response, physicians, and especially those in primary care practice, are sounding this alarm: Do everything you can to encourage, even urge, patients to catch up on their vaccinations.

“Vaccinations effectively prevent 17 known diseases, an impact no other single healthcare service can deliver,” Aran said.

Information released by the CDC last fall states that in this country alone, estimates suggest nearly 730,000 people, most of them young, would have died over the last 19 years in the absence of a comprehensive vaccination program. During the same time, the CDC estimates 21 million more hospitalizations would have occurred as a result of infections and diseases preventable through vaccination.

The pandemic has fundamentally altered the way people live, calling for greater flexibility, adaptation and accommodation. “One of the ways we must adapt is in the consistent practice of preventive measures known to offer some level of protection, including masking, social distancing and handwashing. In healthcare settings, these behavioral interventions are required, making clinics and hospitals among the safest places to be, short of staying home,” Aran said. “It has never been more important to adhere to recommended childhood vaccination schedules. The protection afforded in critical developmental years can have lifelong benefits. Conversely, missed vaccinations may also have long-term consequences for health into adulthood.”

Financial hardship and job losses in connection with the pandemic may be reasons individuals and families aren’t seeking routine care. Vaccinations and well-child visits are covered by insurance providers and Medicaid. Aran hopes parents will set aside concerns about economic burdens in favor of keeping childhood vaccinations on track.

Aran suggests that vaccination initiatives and their target goals aren’t as well understood as they should be, largely because educational efforts haven’t been comprehensive enough.

The global pandemic created by COVID-19 has brought renewed focus on vaccines and their power to prevent disease. The pandemic graphically demonstrates how our way of life, and to some extent, the freedom of movement we take for granted, depends heavily on our capacity to protect public health.

“Today, we can’t vaccinate against COVID-19, but we should take advantage of other vaccines available and protect ourselves to the greatest extent possible. Vaccines can keep diseases like influenza, shingles and pneumonia at bay, allowing us to bolster our overall health and give our bodies a fighting chance against other illnesses,” he said.

Healthcare seems very complex, influenced by age, overall health and the presence of any chronic conditions, among other variables. In contrast, many preventive approaches to health are quite simple. “Less than 150 years ago, the germ theory of disease was highly controversial and unproven. Yet, for all we have learned, scores of people continue to resist basic infection prevention measures,” Aran said. “Handwashing remains the first and most effective intervention against disease. It’s not sophisticated or scientifically advanced – even children can do it effectively. It doesn’t require technology or special tools. Handwashing must become a routine, even habitual practice. It is imperative, given what we know, and what we continue to learn about COVID-19.”

Aran explained one of the means healthcare systems use to protect their patients is the process of cohorting, where certain days of the week, certain segments of the day or certain areas of a facility may be devoted to specific patient populations or services.

“We have done everything possible to safeguard our patients against exposure to infection, including COVID-19. You can bring your kids to the doctor with confidence. You know that an entire area, or the whole of an afternoon or morning, is designated as a ‘COVID-19 free’ time or place.” He further emphasized universal masking as a necessary practice. “Everybody is masked, from the people at the front desk to those staffing administrative offices. Masking may present communication challenges, so we must be more expressive with our eyes, words, as well as written communication.”

Aran notes that masking is not a political issue, any more than wearing a seat belt is political. It goes against some notions of “independence,” but in the current time and place, it is an essential component of keeping patients and medical professionals safe. “We are in a time of transition, and by helping people better understand aspects of health and wellness, we can integrate these behaviors and practices as part of our new normal.”

A more difficult but also necessary approach to protection and prevention is the restriction of traffic through healthcare settings of all types. Healthcare professionals understand how connection with family members and close friends promotes healing. Exceptions are made on a case-by-case basis, as many patients, including children and the elderly, require the assistance of another person. The COVID-19 pandemic is credited with driving technological innovation to ensure that connections are maintained. Telehealth and telemedicine are also becoming accepted and standardized channels of healthcare delivery in circumstances that make face-to-face interactions impossible or ill-advised. “Innovation is a positive side effect of the global pandemic that requires all us to push beyond boundaries,” Aran said.

“We really can’t know what might, or could happen with this new virus. Research is active and ongoing in the arena of education, just as we have seen in healthcare. The best minds in education – from preschool to post-grad – are working day and night to come up with models to make education as safe as possible.”

Today, it seems true that children may not become as ill as often as older populations. But current research suggests COVID-19 is more contagious than the flu. Infection is present long before people feel ill or have symptoms of illness, and because people don’t feel “sick,” they are more likely to be interacting with others and spreading the infection. “With seasonal flu and other familiar illnesses, we feel crummy, and we stay home. Our limited experience with COVID-19 is that kids are particularly asymptomatic, which magnifies opportunities to spread illness among classmates and teachers, as well as family members.”

Among the silver linings of COVID-19’s dark cloud is a new opportunity to consider cultural impact. Questions such as, “How are we to live our lives in community with accountability to each other for protecting our health?” may be answered differently in the post-pandemic world.

“We must understand that vaccination is a matter of public trust and accountability,” he said. “To vaccinate or not is more than a personal choice or preference. It’s something we do to protect each other, not just in our homes, neighborhoods, schools or workplaces. Through the lens of COVID-19, it is clear that we’re part of a global community, now more than ever.”

Aran is confident that our community, our state and indeed our world, will adapt through the process of changed thoughts and attitudes. “Coronavirus is not going away. We will be challenged in establishing a new normal. We must begin to think of preventive care as essential – not optional.” He said good health for adults and children requires team-based care delivered by caring and skilled providers. “You’re not expected to know everything. Think of your primary care physician as the quarterback of your care team.”

While there are circumstances where medical interventions may be appropriate and necessary, Aran underscored proactive steps to maximize good health and minimize the likelihood of chronic conditions or catastrophic outcomes.

Proactive health steps:

• Stop smoking.
• Maintain a healthy body weight.
• To achieve a healthy body weight, work with your doctor to implement a personalized weight-loss plan. Set realistic long-term goals, focused on months and years as opposed to days and weeks.
• Exercise regularly with a goal of 150 minutes of aerobic activity weekly. Incorporate some form of weight/resistance training two to three days each week to counter age-related muscle loss.
• Drink alcohol only in moderation, if at all.
• Comply with CDC guidelines for preventive screenings for breast cancer, colon cancer, uterine cancer, bone fractures and skin cancer.
• Adopt personal daily hygiene habits that promote wellness: handwashing, dental care and adequate sleep.
• Use prescribed drugs, especially pain medications, only as medically necessary. If this is a problem, work with a primary care physician to seek solutions.
• Ask your PCP for guidance on appropriate nutrition consistent with age, medical conditions or other relevant factors.
• Be your own advocate for mental health. If concerns are known, or identified by those close to you, work with your PCP to find appropriate care.

“If people need opportunities for self-determination, these are important matters of individual choice. Our physiologies have a finite number of ways to combat infections, cancer and chronic diseases. Like handwashing, many are simple and obvious. Not all the other lifestyle changes are easy, but we can and should do them.”

To learn more, visit oumedicine.com.