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Many hospitals, clinics and dental offices in some places around the U.S. are beginning to open now for routine, preventative care that was postponed in the early days of the coronavirus pandemic. But still, patients wonder: Is it safe to go?
Michael LeVasseur, a visiting assistant professor of epidemiology and biostatistics at Drexel University in Philadelphia, says a lot of his friends and family members have been asking him that question, along with other queries about the pandemic. So many questions, that he put together two YouTube videos to try to address them at once.
LeVasseur’s general advice is to contact your doctor — the best advice for you may still vary, depending on your situation and where you live. But he says he’s confident that physicians who are accepting patients will be cleaning their offices regularly and taking other precautions to prevent the spread of the coronavirus.
Neal Goldstein at Drexel University and Aimee Palumbo at Temple University, both epidemiologists, urge a number of specific precautions that concerned patients can ask medical and dental staff about when scheduling an appointment:
- Do the staff and patients wear masks at all times?
- Do the staff have enough masks and protective equipment?
- Will there be a limit on how many people can be in a waiting room?
- Are the staff being tested for COVID-19?
- How often are staff cleaning the waiting rooms and offices?
- If you don’t drive, can you take public transit while keeping your distance from other people and washing your hands before and afterward?
Many of the offices and hospitals opening back up for elective and routine medical appointments in the Philadelphia area highlight other precautions they are now taking, too, such as screening patients by phone a day or two ahead of the appointment for any sign of illness, checking for fever at the hospital entrance and testing patients for COVID-19 ahead of procedures.
For most routine checkups, the decision about whether to start getting preventive care again should be easy, Palumbo says: “The people that are at highest risk of COVID or poor outcomes from COVID are also the ones that … are going to benefit the most also from these routine procedures, so we have to recognize that these things still do need to happen. It’s better to treat something sooner than later, so it is still important to continue their care even while this is going on.”
Neil Fishman, an infectious disease specialist and chief medical officer at the Hospital of the University of Pennsylvania, says that, broadly speaking, fewer patients have been coming in to medical offices with routine medical problems. That worries him.
“We know COVID-19 did not cure cancer, COVID-19 did not cure heart disease,” he says, “so that means that there are a lot of people who have been afraid to get routine health care either for existing conditions or for … as-yet-undiagnosed conditions.
“It’s critical,” Fishman adds, “for people to get [regular] physical exams, to get gynecologic checkups, to get mammograms, and colonoscopies, and particularly flu shots during cold and flu season.”
“We have seen what a world without vaccines looks like,” he says. “It looks like this pandemic that we’re experiencing — and it would be even more devastating if we saw a recurrence of vaccine-preventable illnesses because people are avoiding health care out of fear.”
Some of that avoidance of care that should continue has already happened. A report from the Centers for Disease Control and Prevention last month showed a drop in vaccinations among children age 2 or younger in Michigan during the pandemic, compared to similar periods in the past few years.
“The observed declines in vaccination coverage might leave young children and communities vulnerable to vaccine-preventable diseases such as measles,” the authors write. “If measles vaccination coverage of 90%–95% (the level needed to establish herd immunity) is not achieved, measles outbreaks can occur.”
At the same time, it can be difficult to talk to patients about coming back for routine appointments. In a May 27 editorial in the medical journal JAMA: Internal Medicine, David Asch, a professor of medicine and health policy at the University of Pennsylvania, writes that “the biggest challenge in helping patients feel safe is doing so in a way that is not itself scary.”
“Hospitals should pay attention to how they may be perceived to ensure that they do not inadvertently scare away the patients who need them,” Asch writes.
Fishman at Penn Medicine agrees.
“People are anxious when they’re visiting physicians or other health care providers; the anxiety is going to be ever more increased by the changes that COVID-19 are mandating now,” he says. “I always try to think about how a patient would feel — how my mother would feel — if they saw someone walking in the room with a mask and a face shield on, because that’s not what you normally experience.”
Fishman has, indeed, talked to his mother, who has a chronic illness and was briefly hospitalized at the beginning of the pandemic, about whether she should go to her routine follow-up visits. He says she goes to those appointments — but he does the grocery shopping for her, to reduce the risks she might encounter there.
There are some procedures that might be done virtually or just postponed. Jeffrey Jahre, an infectious disease specialist at St. Luke’s University Health Network in Bethlehem and senior vice president of medical and academic affairs, says physical therapists at St. Luke’s have been seeing a lot more patients virtually.
The American Physical Therapy Association released general guidelines for their members in May, suggesting virtual visits for patients who are at risk of getting severely ill from a COVID-19 infection or who are concerned about an inpatient visit – especially if the alternative to a virtual visit is no care at all.
Many dental offices are open in Philadelphia, says David Tecosky, a dentist in in the city, though most still have not returned to doing cosmetic procedures, such as applying custom-made veneers to cover the front of stained or chipped teeth.
Tecosky says he has a two-month or more backlog of appointments, and is starting to again see patients for preventive checkups, as well as emergency procedures to treat infections, or cracked teeth that could lead to pain and problems with eating. He recommends calling your dentist if you’ve missed an appointment in recent months because of the pandemic, to see if it’s time for you, too, to reschedule.
While a dentist might have scheduled 10 patients a day before the pandemic, Tecosky notes that can’t happen now, with the various social distancing measures that need to be taken into account, along with the new need to change gowns and other personal protective equipment between patients. Tecosky now wears hairnets, for example, which he wasn’t doing before the pandemic.
His offices has also added other new measures to protect staff and patients — such as plastic screens at the front desk, more distance between waiting room chairs, and curtains in the operating area. The CDC has more detailed guidance for dental settings.
Tecosky says he and his whole team have been taking patients’ phone questions in recent weeks, and the patients calling have not been reluctant to come back for appointments.
“Even though dentistry is not known to be a place that people flock to go to because they love to, we are finding that patients are not canceling appointments or … saying, ‘oh, I don’t want to come in,’ or ‘Wait six months’ or ‘I’m going to wait ’til this all passes.'”
However, he says, he expects the pandemic will produce lasting changes to how dentists practice. For one thing, masks that used to cost $10 now cost $30. Early in the pandemic, he says, had to put most of his staff of six or seven people on temporary furlough because the office was only permitted to provide urgent care initially. They are all back at work now, Tecosky says, but the office is only getting around 20 percent of the money earned in pre-pandemic times — far below the amount needed to cover overhead costs. All dentists, he says, will keep trying to figure out ways to get patients the care they need, but it could mean a rise in fees.
Eiffel Tower Reopens In Paris, After A 3-Month Shutdown
The Eiffel Tower reopened to visitors Thursday morning, after being shut down for more than three months due to the COVID-19 pandemic. It was the Paris landmark’s longest closure since World War II.
The reopening is a dramatic sign of people finally reclaiming public spaces in France, after more than 100 days of restrictions. But the tower’s highest point is still not open – and for now, visitors will need to take the stairs.
The stairs-only rule is one of several restrictions at the site, which draws millions of tourists during a normal year. Face masks are compulsory for all visitors over the age of 11, and physical distancing markers are in place.
To keep people from crossing paths on the stairs, visitors will ascend on the Eiffel Tower’s East pillar and descent on the West pillar, the Eiffel Tower website states.
🇫🇷 Premiers visiteurs aux 1er et 2e étages 😃 10 mn de montée par étage seulement ! 💖
🇬🇧 Our first visitors arrive at the 1st and 2nd floors. 10 minutes only to climb each level 💪#tourEiffel #EiffelTower pic.twitter.com/GBf26ElSAD
— La tour Eiffel (@LaTourEiffel) June 25, 2020
The reopening took place on a sunny and clear morning, promising wide views of the city. The tower’s return was widely celebrated, with Paris Mayor Anne Hidalgo hailing the reopening. As the first visitors prepared to make their way up, a band of drummers performed in the plaza at the tower’s base.
Elevator service inside the monument is slated to return on July 1. For those who can’t wait, a ticket to walk up to the Eiffel Tower’s second floor – the wider area that cuts off just as the tower narrows toward its spire – costs 10.40 euros (about $11.65).
Tickets are being sold online, in 30-minute increments. Shortly after noon local time Thursday, spots were still open through the afternoon, although the evening tickets had all been claimed, presumably by people eager to see how the City of Lights comes to life in the night, even during a pandemic.
A French government official declared the coronavirus to be “under control” in early June. Days later, France joined the rest of the European Union in lifting many border restrictions within the bloc – part of a plan to salvage part of the summer tourism season.
There are signs that the virus is remaining under control. France’s positive test rate for the coronavirus is 1.5%, according to the most recent data from the national public health agency. Only two of its 104 departments are considered to be in a highly vulnerable situation – and those are in islands in the Caribbean and the Indian Ocean.
France has confirmed 161,348 coronavirus cases, including 29,731 deaths, according to government data.
‘Gone With The Wind’ Returns To HBO Max With New Introduction
Gone With The Wind has returned to the streaming service HBO Max after it was removed earlier this month because of its benign portrayal of American slavery. The film now features a new introduction by film scholar and Turner Classic Movies host Jacqueline Stewart.
In the introduction, Stewart addresses the film’s problematic depiction of the Antebellum South.
“Eighty years after its initial release, ‘Gone With the Wind’ is a film of undeniable cultural significance,” she says. “It is not only a major document of Hollywood’s racist practices of the past but also an enduring work of popular culture that speaks directly to the racial inequalities that persist in media and society today.”
Stewart adds that the film depicts a “world of grace and beauty, without acknowledging the brutalities of the system of chattel slavery upon which this world is based.”
The streaming service also added two companion videos along with the return of the film. One video features a panel discussion on the film’s controversial legacy and another provides more information about Hattie McDaniel, who in 1940 became the first African American to win an Oscar for her portrayal of the enslaved “Mammy.”
The 1939 film has long been the subject of criticism, with some saying it portrayed the Confederacy with sentimentality and fondness. Recent protests for racial justice sparked by the police killing of George Floyd renewed these concerns. Screenwriter, producer and director John Ridley wrote an op-ed for the Los Angeles Times earlier this month calling on HBO Max to remove Gone With the Wind from its library.
“The movie had the very best talents in Hollywood at that time working together to sentimentalize a history that never was,” Ridley wrote. “And it continues to give cover to those who falsely claim that clinging to the iconography of the plantation era is a matter of ‘heritage, not hate.’ “
A spokesperson for the streaming service told NPR in a statement at the time of the film’s removal that the “racist depictions” in the film were “wrong then and wrong today, and we felt that to keep this title up without an explanation and a denouncement of those depictions would be irresponsible.”
The spokesperson added that aside from the new introduction, the movie itself would not be altered once it returned, “because to do otherwise would be the same as claiming these prejudices never existed.”
Stewart reiterated those sentiments in her introduction, acknowledging that while watching Gone With The Wind and other classic films could be uncomfortable or painful, the films should be available in their original form to “invite viewers to reflect on their own beliefs when watching them now.”
Both Chambers Of Congress Back For First Time During Pandemic Amid Questions On Tests
On Thursday, the House and Senate will be in session at the same time, for the first time, since the pandemic began more than three months ago.
While the 100-member Senate resumed its regular floor business in May, the much larger House of Representatives has met sparingly. With more than 430 members, the lower chamber faces higher risks for an outbreak.
And like many other workplaces around the country, Congress has had to ration tests for the coronavirus. Much of the work by employees, aides and lawmakers is being done remotely. Last month, the House approved new rules allowing proxy voting and hearings by video conference.
“Rationing tests for members of Congress … to me, it’s maddening,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “Like, this is no way to run a country.”
But there have been some improvements. The attending physician to Congress can now test asymptomatic members, a senior Democratic aide told NPR. Previously, only some sick members could access tests.
Meanwhile, the Capitol remains closed to the general public for tours and visits. And those still meeting there largely adhere to the attending physician’s guidance to maintain social distancing and wear masks.
“Everyone should just wear a damn mask, like you guys are, like I am right now,” Sen. Marco Rubio, R-Fla., told reporters Wednesday.
Members of Congress saw a spike in cases at the start of the pandemic but have largely flattened their curve, with a total of nine cases.
But Capitol workers — which include staff members, Capitol Police officers and those who maintain operations — have seen a larger influx of cases, with more than 60 by mid-June, according to a congressional aide.
“Those are the ones that we should be concerned about developing some long-term testing protocols for, because it’s not just about the members,” Rep. Rodney Davis, R-Ill., ranking member on the House Administration Committee, told NPR recently.
Davis has been on the hunt for a new testing program for Congress. This month, he wrote House Speaker Nancy Pelosi, D-Calif., asking for the attending physician to partner with the military or a private vendor to test 2,000 people or more a week.
But so far Pelosi and Senate Majority Leader Mitch McConnell, R-Ky., have said Congress shouldn’t get prioritized testing ahead of essential workers.
The chair of the House Administration Committee, Rep. Zoe Lofgren, D-Calif., agrees with that plan — for now.
“I think until the country is in better shape, we’re not going to be in a position to test everybody who comes into the Capitol,” Lofgren said.
Experts such as Jha say national testing still hasn’t reached recommended levels. Among those showing little interest in boosting it is President Trump, who told a rally last weekend in Tulsa, Okla., that he asked for testing to be slowed.
On Tuesday, Trump told reporters he wasn’t kidding when he made the comments.
“Testing is a double-edged sword,” he said.
On The COVID-19 Campaign Trail, Montana’s Gov. Steve Bullock May Be Getting A Boost
At a free, mass testing site on Montana’s Flathead Reservation, hundreds of people are queued up in idling cars. They’re waiting an hour or more for the irritating nose swab test for COVID-19, but most like Francine Van Maanen are just grateful to finally get one.
“We enjoyed the fact that they had this testing available to us so why not get checked,” she says, while waiting in line with her husband.
Nurses wearing face shields put the swabs in plastic tubes while busily scribbling notes on clipboards. This “mass surveillance” testing event was part of Gov. Steve Bullock’s recent goal to do community surveillance testing of 60,000 Montanans a month — the state has yet to come close to hitting that.
“This is big, this is overwhelming,” Bullock told tribal and county health officials working the recent Flathead event. “Now let’s start talking about when we’re going to do it again.”
Under Bullock’s watch, Montana now has the lowest coronavirus infection rate in the nation, and among its lowest hospitalizations and deaths. Daily new case numbers have been going up for the last two weeks, but only by single or double digits. The pandemic — and Bullock’s handling of it as the state’s top leader — is fast becoming a central issue in his campaign to unseat Republican Sen. Steve Daines.
The race is one of a few around the country that could decide which party controls the U.S. Senate next year. It’s also expected to be one of the most expensive in the nation, and likely the most expensive in Montana’s history.
Bullock, citing advice from local public health officials, implemented a statewide stay-at-home order and closed most schools down earlier than some neighboring states on March 28. Montana also began a phased reopening earlier than most, around the middle of last month. By June 1, citing the low number of cases, Bullock lifted a 14-day quarantine requirement for travelers, saying there is ample contact tracing now.
“We may see positive cases,” he says. “But we’ll also identify those positive cases before they start spreading.”
On the Flathead, the one-time presidential candidate was in his element, wearing jeans and cowboy boots, his Ray-Bans shielding against the glare from the sun hitting the late season snow high on the Mission Mountains.
Bullock is termed out as governor after this year. After months of insisting he wouldn’t run for Senate, just before the filing deadline, he changed his mind in March. Then a few days later, the pandemic hit.
“I think there’ll be a time for the campaigning side of that,” he says. “But that hasn’t been where I’ve really been putting the time.”
But the pandemic is in the news every day, which so far hasn’t exactly hurt Bullock who until recently had been seen as the underdog.
“He’s dominating the airwaves, you can’t turn around without seeing a story about the governor,” says Chris Mehl, the non-partisan mayor of Bozeman.
Bozeman is the state’s fastest growing city. It’s swung blue lately, in part due to a wave of newcomers attracted by the area’s outdoor and recreation amenities and the increased ability to telecommute. The university town near to ski resorts and Yellowstone National Park was also Montana’s initial hotspot for cases.
“It’s in a sense become what he’s tied to,” Mehl says. “The issue for him is the competency of handling the pandemic, both on a health side but also on an economic recovery side.”
‘Jobs and economy’ election
Bozeman is also the hometown of Republican Steve Daines. Lately Daines has struggled to get into the local news as much as Bullock even after he helped pass a sweeping public lands conservation bill. If these were normal times, that would have been big news considering the growing influence of the outdoor recreation economy in the state.
Nevertheless, in a phone interview, the senator says he doesn’t think the public health crisis itself will be much of a factor come Fall.
“I think by the time voters start to cast their ballots, this election is going to be a jobs and economy election,” Daines says.
Daines touted his experience helping small businesses, and he predicted unemployment claims will continue to mount if the pandemic continues to hamper economic recovery.
But in Montana right now, Daines’ reelection chances may depend mostly on President Trump remaining popular here.
Daines has positioned himself as one of the president’s staunch supporters. When Trump tweeted the so-called “squad” should go back where they came from, Daines doubled down in support. He was also one of the few Republican senators to publicly praise the president when peaceful protesters were cleared out from in front of the White House so Trump could pose holding a bible.
“Montanans are going to vote for President Trump, he’s going to win Montana,” Daines says. “They’re going to be glad that he’s coming here.”
Trump also came to Montana four times in 2018, failing to unseat the state’s other senator, Democrat Jon Tester. While no dates have been set, his return on behalf of Daines is widely expected and that’s prompting the same public health concerns as at recent rallies in Tulsa and Phoenix.
“That bridge will be crossed when there is a decision made to have a rally,” Daines says.
Montana ticket splitting
Montana is famously all over the map politically. When Daines was elected in 2014, he took over a Senate seat that Democrats had held for 100 years. In 2016, when Trump won Montana by nearly 20 points, Steve Bullock was re-elected as governor.
Just like during his long-shot presidential bid, Bullock is touting his bipartisan record from COVID-19, to Medicaid expansion and showing support for the Keystone pipeline which crosses the state.
“Look, I stood up to President Obama multiple times,” Bullock says. “I’ll work with whoever it is when it’s in the best interest of Montana.
One place Bullock has taken some heat for his handling of the pandemic is in national park gateway towns like West Yellowstone. Montana’s entrance gates opened three weeks after Wyoming’s, as per Bullock’s order.
“I would have loved to have seen us open earlier,” says Travis Watt, general manager for a hotel and a couple other businesses in the tourist-dependent town. “I’m glad he didn’t wait till longer, I know there was a lot of pressure to push until later.”
Watt didn’t vote for Bullock for Governor but he says he likes how he’s managed the pandemic so far.
“It’s a unique situation and you look at some of the things going around in the country and I think Montana sits pretty good,” Watt says.
While Sen. Daines can probably win Montana with a big turnout from Trump’s base and rural voters, Bullock will need people like Watt to consider crossing over, just as he needs coronavirus cases to stay low and the economy to rebound.
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