Preventive care has become one of the victims of the new coronavirus as Americans grapple with a new surge of COVID-19 cases in the fall after being forced to skip routine physicals and screenings this spring.
As December started, the White House coronavirus task force warned the country was "in a very dangerous place" with an extremely high COVID-19 baseline, limited hospital capacity and a post-Thanksgiving surge that would "compromise COVID patient care, as well as medical care overall."
What does it mean for routine medical appointments?
Many doctors are reverting back to scheduling more telemedicine visits, just as they did in the spring, said Dr. Gary LeRoy, chair of the board of directors of the American Academy of Family Physicians.
"We continue to do guarded in-person office visits and have not cancelled wellness care," LeRoy, a family physician in Dayton, Ohio, told TODAY about his own practice. "However, as the numbers of COVID-19 cases continue to escalate this could change."
Dr. Nisa Maruthur, a primary care physician and associate professor of medicine at Johns Hopkins University in Baltimore, is telling most of her patients they should do annual physicals or routine appointments by telemedicine, but she is deciding on a case-by-case basis if an in-person visit would be more appropriate.
"COVID-19 cases are on the rise, and we do need to enforce physical distancing to the extent that we can," Maruthur said.
Earlier this year, the American Cancer Society reported "a substantial decline in cancer screening," which is worrisome for a system set up to prevent disease or catch it early — when there's the best chance to recover.
Between March 15 and June 16, 285,000 breast, 95,000 colon and 40,000 cervical exams to detect cancer were missed, according to an analysis by Epic Health Research Network released in July. That represents deficits of 63%, 64% and 67% respectively based on the number of screenings that would be normally expected in an average year.
“This COVID crisis has shined a searing spotlight on the importance of preventive health care in our country and across the world,” LeRoy noted.
Here’s what to know about delaying routine medical appointments in the age of COVID-19. Bottom line: Always ask your doctor if you can safely postpone care.
Annual physical or wellness visit:
The once-a-year check-up has long been considered a standard of care, but there’s been debate over whether it’s really needed, especially for healthy adults under 50. Some health policy experts say annual physicals are a waste of time and money for many people.
But LeRoy still considered it an important visit that doesn’t only have to happen once a year.
“You want to keep your body, your most precious asset, in tune all the year long,” he said.
“We don’t want to give the public the impression that wellness visits are not essential because they are, especially for diabetics and hypertensives and people with chronic lung diseases. They really are essential monitors of the status of their overall health.”
Most issues that are covered during annual checkups can be addressed via telemedicine and your doctor can decide at that point if an in-person visit for a physical exam or other tests is needed, Maruthur said. Ask what's right for you.
"A doctor who knows you can help to determine if the benefits of an in-person visit outweigh the risks," she noted.
If your annual visit was canceled, don’t assume it’s OK to skip it this year. LeRoy advised calling your doctor and asking if and when it should be rescheduled.
Even with patients who have had a telemedicine visit, he’d still rather see them in person at some point.
“Telemedicine is a tool; it’s not a replacement for the patient-physician interaction... You cannot practice the art of medicine virtually,” LeRoy said, noting there are many more clues he can notice and problems he can examine when the patient is in front of him, not to mention checking vital signs and taking blood tests.
Primary care physicians also often pick up on depression, he said.
The decision whether to go in for a cancer screening while COVID-19 is surging requires careful consideration of the risks and benefits, the American Cancer Society advised. Talk to your doctor about whether it's best to be screened now or postpone for a later date.
“For people at average risk, a one- or two-month delay is not going to be a major problem,” said Dr. J. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society. People at high risk for cancer should talk with their doctor about what steps to take, he advised.
People who experience possible cancer symptoms, like finding a lump or seeing blood in the toilet bowl, should contact their doctor now.
When it comes to routine gynecological appointments, it's unclear whether a yearly pelvic exam is necessary, the U.S. Preventative Services Task Force said in 2016. Women should talk to their doctors about whether that type of annual exam is right for them, experts advised.
But all women should receive at least one preventive well-woman care visit per year beginning in adolescence, the American College of Obstetricians and Gynecologists said.
The parts of the visit that involve screening, assessment and counseling can be done via telehealth, while the in-person physical exam can be deferred to a later date or performed on an as-needed basis, the organization noted.
The frequency of eye exams should depend on several factors including a person’s age and medical history, according to the American Academy of Ophthalmology.
School-age children should be evaluated every one to two years, while an annual exam isn’t routinely needed for healthy adults under 40. Older adults and those with risk factors for eye disease may need an eye exam once every one to two years.
Most routine care can be rescheduled, but treatment for eye emergencies should not be delayed.
Conditions that would warrant visiting your eye doctor now include:
- Having macular degeneration or diabetic retinopathy and getting regular eye injections;
- Changes in vision, including blurry, wavy or blank spots in your field of vision
- An eye injury, even if it seems minor
- Many new floaters or flashes in your vision
- Sudden vision loss
- Eye pain, headache, red eye, nausea and vomiting.
For an in-person appointment, your eye doctor may use a special plastic breath shield on the slit lamp machine they use to look into your eyes, the AAO noted. He or she may also ask you to wait to speak until they're a safe distance away after the eye exam is complete.
Your dermatologist will determine how often you need a skin exam to detect cancer based on risk factors such as skin type, history of sun exposure and family history.
People with a history of melanoma should have a full-body exam by a dermatologist at least once a year, the American Academy of Dermatology said.
Doctors encourage people do regular self-exams using the ABCDEs of melanoma. If they’re concerned about a specific mole and don't want to go to a doctor in person, they can point it out during a virtual appointment or send a photo. That's how a Missouri dermatologist diagnosed a patient's melanoma in June.
“Even during the pandemic, a dermatologist can examine the spot via telemedicine to determine if it needs to be tested or removed, and if so, he or she may ask you to come into their office for an in-person appointment,” said Dr. Bruce Thiers, a board-certified dermatologist in Charleston, South Carolina and AAD president, in a statement.
“This is especially important if you have a history of skin cancer, sun exposure, indoor tanning or any other risk factors.”
The American Dental Association "firmly believes" dental care can continue to be delivered safely, it said in November, noting there's been no documented transmission of COVID-19 in a clinical dental setting. The group also pointed to a study published in October that found fewer than 1% percent of dentists nationwide were found to be COVID-19 positive.
The association recommends regular dental visits at intervals determined by a dentist, which can help prevent dental health problems or spot them early when treatment is likely to be simpler and more affordable, it noted.
Patients may find added safeguards such as no spitting and the use of a special suction tool to vacuum any droplets from the air. Dental hygienists may use hand scaling rather than ultrasonic scaling when cleaning teeth to minimize aerosols.
There’s little harm in waiting one to two years between dental exams for people who have a history of few or no cavities, maintain good oral health, haven’t started new prescription medications and haven’t had significant health changes, according to Dr. Zuri Barniv, a dentist based in Sunnyvale, California, whose “Straight Up Doc” blog answers patients’ common questions.
Otherwise, it’s best to have an annual exam, he noted.
This story was updated on Dec. 3, 2020.