Is Now the Right Time to Get Your Annual Physical or Dental Cleaning?
By Joni Sweet
Should you skip your annual checkup? The answer would have been a resounding "no" if you asked most doctors before the pandemic.
But with the risk of COVID-19, the answer isn't so clear anymore.
Many states banned nonessential medical procedures in an effort to stop the spread of the disease. Patients have also put off routine care out of fear that they could be exposed to the new coronavirus at hospitals and doctors' offices.
With states starting to open up, you might be wondering whether you can finally get that checkup, dental cleaning, or cancer screening you've been pushing off.
Here's what you need to know about scheduling preventive care appointments during the pandemic
Are States Allowing Preventive Care Visits?
First things first: If you're experiencing a medical emergency, don't delay treatment.
While there's the potential that you could be exposed to infections at the emergency room, the health risks of avoiding urgent medical care could be far more severe.
Hospitals have also implemented precautionary measures, like distributing masks to patients, that help cut down the risk of viral exposure.
Now that that's out of the way, is it possible to start catching up on routine healthcare appointments, like physicals and dental cleanings?
"Different places are in different stages of opening up," said Dr. Arvind Ankireddypalli, primary care physician and geriatrician at Methodist Le Bonheur Healthcare. "Preventative services might not even be available in some communities, [and in others] medical appointments may be on a case-by-case basis."
Like medical care, dental appointments fall under similar guidelines.
"Dental cleanings are nonessential treatments, and the department of health in most states only allowed emergency dental treatments to be completed during COVID-related shutdowns," said Dr. John Nelson of Midtown Dental Miami.
"As states begin to slowly reopen and restrictions begin to relax, dental cleaning services are starting to be provided again. I expect [that within the next few weeks], barring any setback, your local dental office will begin providing cleanings," he said.
Check with your local and state health departments for the most up-to-date guidelines.
Is it Safe to Go to the Doctor?
If your state is open (or will end its lockdown soon), you may be able to start booking preventive care appointments, like Pap smears, cancer screenings, checkups, and dental cleanings.
But is it worth the risk of possible exposure to the new coronavirus?
Opinions vary among healthcare providers and the conditions of their patients, as well as the infection rate in their communities and availability of personal protective equipment.
Dr. Len Horovitz, internist, pulmonary specialist, and director of Carnegie Medical, recommends that patients avoid delaying their annual physical or other types of preventive care.
"You will encounter problems that are best seen earlier rather than later," he said. "It is possible to provide a safe environment for a patient in the doctor's office. There's no reason for people to put off an annual exam; these are important appointments that help keep problems from getting out of control."
In an effort to curb the spread of infection, Horovitz has been following a strict set of procedures at his office, including allowing just one patient in at a time, requiring patients to wear masks and gloves, and disinfecting the examination room between every patient.
Other physicians, like Ankireddypalli, conduct a risk-benefit analysis for every patient before agreeing to see them in person.
"It is probably not appropriate to keep delaying visits for high-risk patients, like older adults or people with chronic conditions," he explained.
Role of Telehealth Visits
Telemedicine visits, where doctors connect with patients via phone or video chat, can be an option if in-person appointments are risky or prohibited.
The Centers for Medicare & Medicaid Services and some private insurance companies have expanded coverage for telehealth services during the pandemic. As a result, some practices have seen the use of telemedicine services soar over the last few months.
"Telemedicine is a way that patients can be seen, evaluated, counseled, and informed about their healthcare without being exposed to the dangers of going into lobbies and offices," said Dr. Steve Ommen, cardiologist and associate dean of the Mayo Clinic Center for Connected Care, which offers telemedicine services.
"It is particularly relevant for patients who already have a relationship with a provider, the appointment is for an ongoing care episode, and the patient doesn't need to be touched," he said.
A virtual doctor's visit can't be a substitute for all routine care, though. Cancer screenings, blood draws, evaluations of lumps, Pap smears, and other services still need to be done in person.
But even if you do have to go to the doctor's office, telehealth services can help cut down on the amount of time you spend there, thus potentially reducing your exposure to the new coronavirus and other germs.
"Patients often come to the Mayo Clinic for a major evaluation and then sit with us to go over the results, but we can go over the results through telemedicine when they're at home, rather than having them stay another day," Ommen explained.
He adds that telemedicine services generally won't suffice for patients who are unwell or experiencing any new symptoms.
"That's a different level of acuity than a health maintenance visit," he said.
With so much uncertainty, the best thing you can do is keep an open line of communication with your doctor, dentist, and the rest of your healthcare team.
Don't just push off your routine services indefinitely, doctors say.
"By delaying preventative care, we can miss the window of catching certain conditions early. Patients can work with their healthcare providers to put a plan in place and get their services back on track," Ankireddypalli said.
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By Eric Tate and Christopher Emrich
Disasters stemming from hazards like floods, wildfires, and disease often garner attention because of their extreme conditions and heavy societal impacts. Although the nature of the damage may vary, major disasters are alike in that socially vulnerable populations often experience the worst repercussions. For example, we saw this following Hurricanes Katrina and Harvey, each of which generated widespread physical damage and outsized impacts to low-income and minority survivors.
Mapping Social Vulnerability<p>Figure 1a is a typical map of social vulnerability across the United States at the census tract level based on the Social Vulnerability Index (SoVI) algorithm of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1540-6237.8402002" target="_blank"><em>Cutter et al.</em></a> . Spatial representation of the index depicts high social vulnerability regionally in the Southwest, upper Great Plains, eastern Oklahoma, southern Texas, and southern Appalachia, among other places. With such a map, users can focus attention on select places and identify population characteristics associated with elevated vulnerabilities.</p>
Fig. 1. (a) Social vulnerability across the United States at the census tract scale is mapped here following the Social Vulnerability Index (SoVI). Red and pink hues indicate high social vulnerability. (b) This bivariate map depicts social vulnerability (blue hues) and annualized per capita hazard losses (pink hues) for U.S. counties from 2010 to 2019.<p>Many current indexes in the United States and abroad are direct or conceptual offshoots of SoVI, which has been widely replicated [e.g., <a href="https://link.springer.com/article/10.1007/s13753-016-0090-9" target="_blank"><em>de Loyola Hummell et al.</em></a>, 2016]. The U.S. Centers for Disease Control and Prevention (CDC) <a href="https://www.atsdr.cdc.gov/placeandhealth/svi/index.html" target="_blank">has also developed</a> a commonly used social vulnerability index intended to help local officials identify communities that may need support before, during, and after disasters.</p><p>The first modeling and mapping efforts, starting around the mid-2000s, largely focused on describing spatial distributions of social vulnerability at varying geographic scales. Over time, research in this area came to emphasize spatial comparisons between social vulnerability and physical hazards [<a href="https://doi.org/10.1007/s11069-009-9376-1" target="_blank"><em>Wood et al.</em></a>, 2010], modeling population dynamics following disasters [<a href="https://link.springer.com/article/10.1007%2Fs11111-008-0072-y" target="_blank" rel="noopener noreferrer"><em>Myers et al.</em></a>, 2008], and quantifying the robustness of social vulnerability measures [<a href="https://doi.org/10.1007/s11069-012-0152-2" target="_blank" rel="noopener noreferrer"><em>Tate</em></a>, 2012].</p><p>More recent work is beginning to dissolve barriers between social vulnerability and environmental justice scholarship [<a href="https://doi.org/10.2105/AJPH.2018.304846" target="_blank" rel="noopener noreferrer"><em>Chakraborty et al.</em></a>, 2019], which has traditionally focused on root causes of exposure to pollution hazards. Another prominent new research direction involves deeper interrogation of social vulnerability drivers in specific hazard contexts and disaster phases (e.g., before, during, after). Such work has revealed that interactions among drivers are important, but existing case studies are ill suited to guiding development of new indicators [<a href="https://doi.org/10.1016/j.ijdrr.2015.09.013" target="_blank" rel="noopener noreferrer"><em>Rufat et al.</em></a>, 2015].</p><p>Advances in geostatistical analyses have enabled researchers to characterize interactions more accurately among social vulnerability and hazard outcomes. Figure 1b depicts social vulnerability and annualized per capita hazard losses for U.S. counties from 2010 to 2019, facilitating visualization of the spatial coincidence of pre‑event susceptibilities and hazard impacts. Places ranked high in both dimensions may be priority locations for management interventions. Further, such analysis provides invaluable comparisons between places as well as information summarizing state and regional conditions.</p><p>In Figure 2, we take the analysis of interactions a step further, dividing counties into two categories: those experiencing annual per capita losses above or below the national average from 2010 to 2019. The differences among individual race, ethnicity, and poverty variables between the two county groups are small. But expressing race together with poverty (poverty attenuated by race) produces quite different results: Counties with high hazard losses have higher percentages of both impoverished Black populations and impoverished white populations than counties with low hazard losses. These county differences are most pronounced for impoverished Black populations.</p>
Fig. 2. Differences in population percentages between counties experiencing annual per capita losses above or below the national average from 2010 to 2019 for individual and compound social vulnerability indicators (race and poverty).<p>Our current work focuses on social vulnerability to floods using geostatistical modeling and mapping. The research directions are twofold. The first is to develop hazard-specific indicators of social vulnerability to aid in mitigation planning [<a href="https://doi.org/10.1007/s11069-020-04470-2" target="_blank" rel="noopener noreferrer"><em>Tate et al.</em></a>, 2021]. Because natural hazards differ in their innate characteristics (e.g., rate of onset, spatial extent), causal processes (e.g., urbanization, meteorology), and programmatic responses by government, manifestations of social vulnerability vary across hazards.</p><p>The second is to assess the degree to which socially vulnerable populations benefit from the leading disaster recovery programs [<a href="https://doi.org/10.1080/17477891.2019.1675578" target="_blank" rel="noopener noreferrer"><em>Emrich et al.</em></a>, 2020], such as the Federal Emergency Management Agency's (FEMA) <a href="https://www.fema.gov/individual-disaster-assistance" target="_blank" rel="noopener noreferrer">Individual Assistance</a> program and the U.S. Department of Housing and Urban Development's Community Development Block Grant (CDBG) <a href="https://www.hudexchange.info/programs/cdbg-dr/" target="_blank" rel="noopener noreferrer">Disaster Recovery</a> program. Both research directions posit social vulnerability indicators as potential measures of social equity.</p>
Social Vulnerability as a Measure of Equity<p>Given their focus on social marginalization and economic barriers, social vulnerability indicators are attracting growing scientific interest as measures of inequity resulting from disasters. Indeed, social vulnerability and inequity are related concepts. Social vulnerability research explores the differential susceptibilities and capacities of disaster-affected populations, whereas social equity analyses tend to focus on population disparities in the allocation of resources for hazard mitigation and disaster recovery. Interventions with an equity focus emphasize full and equal resource access for all people with unmet disaster needs.</p><p>Yet newer studies of inequity in disaster programs have documented troubling disparities in income, race, and home ownership among those who <a href="https://eos.org/articles/equity-concerns-raised-in-federal-flood-property-buyouts" target="_blank">participate in flood buyout programs</a>, are <a href="https://www.eenews.net/stories/1063477407" target="_blank" rel="noopener noreferrer">eligible for postdisaster loans</a>, receive short-term recovery assistance [<a href="https://doi.org/10.1016/j.ijdrr.2020.102010" target="_blank" rel="noopener noreferrer"><em>Drakes et al.</em></a>, 2021], and have <a href="https://www.texastribune.org/2020/08/25/texas-natural-disasters--mental-health/" target="_blank" rel="noopener noreferrer">access to mental health services</a>. For example, a recent analysis of federal flood buyouts found racial privilege to be infused at multiple program stages and geographic scales, resulting in resources that disproportionately benefit whiter and more urban counties and neighborhoods [<a href="https://doi.org/10.1177/2378023120905439" target="_blank" rel="noopener noreferrer"><em>Elliott et al.</em></a>, 2020].</p><p>Investments in disaster risk reduction are largely prioritized on the basis of hazard modeling, historical impacts, and economic risk. Social equity, meanwhile, has been far less integrated into the considerations of public agencies for hazard and disaster management. But this situation may be beginning to shift. Following the adage of "what gets measured gets managed," social equity metrics are increasingly being inserted into disaster management.</p><p>At the national level, FEMA has <a href="https://www.fema.gov/news-release/20200220/fema-releases-affordability-framework-national-flood-insurance-program" target="_blank">developed options</a> to increase the affordability of flood insurance [Federal Emergency Management Agency, 2018]. At the subnational scale, Puerto Rico has integrated social vulnerability into its CDBG Mitigation Action Plan, expanding its considerations of risk beyond only economic factors. At the local level, Harris County, Texas, has begun using social vulnerability indicators alongside traditional measures of flood risk to introduce equity into the prioritization of flood mitigation projects [<a href="https://www.hcfcd.org/Portals/62/Resilience/Bond-Program/Prioritization-Framework/final_prioritization-framework-report_20190827.pdf?ver=2019-09-19-092535-743" target="_blank" rel="noopener noreferrer"><em>Harris County Flood Control District</em></a>, 2019].</p><p>Unfortunately, many existing measures of disaster equity fall short. They may be unidimensional, using single indicators such as income in places where underlying vulnerability processes suggest that a multidimensional measure like racialized poverty (Figure 2) would be more valid. And criteria presumed to be objective and neutral for determining resource allocation, such as economic loss and cost-benefit ratios, prioritize asset value over social equity. For example, following the <a href="http://www.cedar-rapids.org/discover_cedar_rapids/flood_of_2008/2008_flood_facts.php" target="_blank" rel="noopener noreferrer">2008 flooding</a> in Cedar Rapids, Iowa, cost-benefit criteria supported new flood protections for the city's central business district on the east side of the Cedar River but not for vulnerable populations and workforce housing on the west side.</p><p>Furthermore, many equity measures are aspatial or ahistorical, even though the roots of marginalization may lie in systemic and spatially explicit processes that originated long ago like redlining and urban renewal. More research is thus needed to understand which measures are most suitable for which social equity analyses.</p>
Challenges for Disaster Equity Analysis<p>Across studies that quantify, map, and analyze social vulnerability to natural hazards, modelers have faced recurrent measurement challenges, many of which also apply in measuring disaster equity (Table 1). The first is clearly establishing the purpose of an equity analysis by defining characteristics such as the end user and intended use, the type of hazard, and the disaster stage (i.e., mitigation, response, or recovery). Analyses using generalized indicators like the CDC Social Vulnerability Index may be appropriate for identifying broad areas of concern, whereas more detailed analyses are ideal for high-stakes decisions about budget allocations and project prioritization.</p>
By Jessica Corbett
Sen. Bernie Sanders on Tuesday was the lone progressive to vote against Tom Vilsack reprising his role as secretary of agriculture, citing concerns that progressive advocacy groups have been raising since even before President Joe Biden officially nominated the former Obama administration appointee.