Chester County Medicine Spring 2021 - 15

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in the reported incidence
of cancer diagnoses, but
experts believe this is
unlikely to be secondary to
a drop in true incidence;
more likely, these cases have
yet to be diagnosed and
will present at advanced
stages. The Director of the
National Cancer Institute,
Dr. Norman Sharpless,
projects as many as 10,000
additional deaths from breast
and colorectal cancer over
the coming decade due to
lost screening opportunities
during the pandemic. It has been estimated that as many as
one third of the excess deaths associated with the pandemic are
from untreated acute emergencies, mental health crises including
overdoses and suicides, and exacerbations of chronic conditions
like heart disease and diabetes.
As we try to recover from the COVID-19 pandemic, the
potential surge of new and exacerbated chronic illnesses, as well as
late-diagnosed cancer cases, may lead us from one health crisis into
another.

How can we get back on a path to good
health?
We should expect - and encourage - patients to re-engage
in care with their primary care providers for acute problems and
routine care that has been delayed over the past year. This is
especially important for patients who may not have had access to
interim telehealth services because of unreliable internet or phone
service. US adults who see a primary care provider have 19%
lower odds of premature death and save 33% on health care costs
compared to those who are cared for only by specialists.
Patients can be reassured that ambulatory care practices are
taking all precautions to minimize risk of infection transmission
based on the guidelines from the CDC, local health departments,
and institutional epidemiology and infectious disease specialists.
Primary care providers have become adept at making dynamic
changes to the delivery of care to provide safe treatment remotely
and in-person as local cases rise and fall. About two-thirds
of primary care organizations have adopted telemedicine and
can provide numerous services using this modality. Insurers
are covering telemedicine visits in most circumstances. At our
practice, all medical providers and staff are screened daily for
COVID-19 symptoms before reporting to work, and anyone with
symptoms is directed to our Occupational Health Department
for further evaluation. Surfaces and equipment are routinely
cleaned between patients using products that are effective against

multiple organisms, including
coronaviruses.
Patients are screened when
they schedule an in-person
appointment and everyone is
required to wear a mask inside
the building. The waiting
rooms are configured to allow
for distance between patients,
and if multiple patients are
expected in the waiting room
at one time, check-in can be
completed from the patient's
vehicle in the parking lot prior
to entering the building. Only
under special circumstances
may patients be accompanied by another person. Hand sanitizer is
available to everyone.
Whether you have acute concerns or are due/overdue for
routine check-ups, screenings, and vaccines, come back to your
PCP. We've been here for you, and we're still here for you!
Sources/Additional Reading:
" Spillover Effects of the COVID-19 Pandemic Could Drive
Long-Term Health Consequences For Non-COVID-19 Patients, "
Health Affairs Blog, October 23, 2020.
Ateeva Mehotra et al., The Impact of the COVID-19 Pandemic on
Outpatient Care: Visits Return to Prepandemic Levels, but Not for All
Providers and Patients (Commonwealth Fund, Oct. 2020).
COVID-19 and cancer. Norman E Sharpless. Science 19 Jun
2020: Vol.368, Issue 6497, pp. 1290
Czeisler ME, Marynak K, Clarke KE, et al. Delay or Avoidance
of Medical Care Because of COVID-19-related Concerns -
United States, June 2020. MMWR Morb Mortal Wkly Rp
2020;69;1250-1257.
Kaiser Family Foundation Health Tracking Poll June 2020
B. Starfield, L. Shi, and J. Macinko, " Contribution of Primary
Care to Health Systems and Health, " Milbank Quarterly, Sept.
2005 83(3):457- 502.
Dr. Jacapraro is an internist with Penn Medicine Primary
Care - Whiteland. She is a graduate of Cornell University
and the University of Maryland School of Medicine and
completed her residency at Johns Hopkins/Bayview
Medical Center. She is also a volunteer physician at CVIM
in West Chester. Her medical interests include preventive
care, patient-centered care, addiction medicine, and
gender affirming care. Dr. Jacapraro lives in Glenmoore
with her husband, daughter, and Golden Retriever.

SPRING 2021 | CHESTER COUNT Y Medicine 15
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Chester County Medicine Spring 2021

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