BRAINERD, Minn. -- Life-saving medical examinations such as mammograms and colonoscopies fell by the wayside as some patients have avoided in-person visits during the coronavirus pandemic.
But with COVID-19 vaccines widely available and face-masking protocols in place, health care providers such as Essentia Health and Lakewood Health System in the Brainerd lakes area are encouraging patients to resume their preventative care regimen with visits to their doctor.
“Initially, especially spring of 2020 when the pandemic started and there were a lot of unknowns about the pandemic, there was a lot of fear and hesitancy,” Dr. Jared Reese of Essentia Health said. “I mean, we were even closed down to in-person visits for a month and a half.
“Early on in the pandemic there was a lot of fear, we didn't know a lot about COVID transmission. It was scary. I mean, I remember barely wanting to go out to the grocery store initially.”
Working through many unknowns in early 2020, health care providers erred on the side of caution.
“Initially, when we were not sure as providers how fast this pandemic would spread across our area, we actually asked people — especially people who we knew would be more vulnerable to the virus — to stay home and to not come in for some of those clinic visits,” said Dr. Christine Albrecht, chief medical officer at Lakewood Health System.
Visits for outpatient care, which had fallen nearly 60% in April, have returned in September to the levels prior to the pandemic, according to a report published in October by Ateev Mehrotra, associate professor of health care policy and medicine at Harvard Medical School.
“After we realized with masking and appropriate distancing and other safety protocols that we could see people safely, we have been encouraging them to come back in and get those exams and preventative care done,” said Albrecht, who sees patients at Lakewood Heath’s Staples and Pillager clinics.
State and local governments lifted many restrictions on travel and nonessential services related to the pandemic when summer ended, and businesses and outpatient practices soon followed suit.
“I think a lot has improved since then, for sure, just as we know more about COVID — this is an evolving situation — and people getting vaccinated has really made a big difference,” said Reese, a family physician who practices at the Essentia Health St. Joseph's-Baxter Clinic.
Researchers at Harvard University, The Commonwealth Fund and Phreesia, a health care technology company, analyzed data on changes in visit volume for the more than 50,000 providers that are Phreesia clients to produce the report that was published in October.
The pandemic has “dramatically altered the delivery of outpatient care. Initially, health care practices deferred elective visits, modified their practices to safely accommodate in-person visits, and increased their use of telemedicine,” according to The Commonwealth Fund, which promotes high-performing health care systems that achieves better access, improved quality and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured and people of color.
It’s still vitally important — maybe even more so now — for people to look out for their health, health care providers said.
“It's extremely important that we get people in for their routine screenings, especially things like a mammogram, colonoscopy screening .. and the reason we do those is because we have very good data that early cancer detection with these screening tests really save lives,” Reese said.
Albrecht added: “We do feel that we are missing some cancers that can be treated earlier because we're not picking them up with screening exams with people not wanting to come in.”
Telemedicine visits gained more acceptance as in-person visits decreased. The remote care practice peaked in mid-April of last year, but its use has slowly and steadily declined, according to The Commonwealth Fund.
“Telehealth is good for certain types of visits, but it is not good for preventative care visits. You need to be able to examine a patient and actually put your stethoscope on their chest and you need to be able to examine their abdomen and look at their skin color. You need to be able to do so many physical exam things that you cannot do via telemedicine,” Albrecht said.
Many people may have put off routine health care and preventive services like screenings and vaccines because they are worried about getting COVID-19, but doctors warn that this could cause problems in the future, according to the U.S. Department of Health and Human Services.
“The earlier people are diagnosed the better the outcome is going to be for their treatment, so I think at this point our message is really that patients should feel safe coming into any Essentia facility,” Reese said of mammograms, colonoscopies and annual physical exams.
Albrecht said of COVID fears and in-person exams, “Children exams did not get done and children are behind on their routine vaccinations for tetanus, pneumonia, hepatitis, meningitis. All kinds of our routine vaccinations that get done at well-child visits are being skipped.”
The U.S. Food and Drug Administration on Monday, Aug. 23, granted full approval to the Pfizer Inc/BioNTech SE COVID-19 vaccine, which many hope will encourage more businesses to mandate their employees be vaccinated as a condition of their employment.
“We have a universal masking policy, we have screeners at the door of all of our clinics and hospitals where you're screened for COVID symptoms, you're asked to put on a mask if you're not already wearing one — and that's enforced."
— Dr. Jared Reese of Essentia Health
That on top of precautions already in place offer optimism to medical professionals.
“We have a universal masking policy, we have screeners at the door of all of our clinics and hospitals where you're screened for COVID symptoms, you're asked to put on a mask if you're not already wearing one — and that's enforced,” Reese said of Essentia Health’s precautions.
“Patients really should feel comfortable coming to see us,” Reese added. “Our staff is largely vaccinated, and in fact we've recently mandated — we're making it a requirement to work at Essential Health to be COVID vaccine-compliant by Nov. 1.”
Employees are expected to receive their first dose of vaccine by Oct. 1 and their second dose in a two-dose series by Nov. 1. There will be a process for requesting a medical exemption based on guidance from the Centers for Disease Control and Prevention or a religious exemption.
“Essentially everyone you're going to come into contact with is going to be vaccinated at our facilities, which I think should provide a little comfort for folks as well,” Reese said.
Crow Wing County is performing better than many of its rural counterparts in terms of COVID-19 vaccination rates, with a 60% vaccination rate for those ages 16 and older.
Other counties in the region with similar COVID-19 vaccination rates to Crow Wing County are Cass and Aitkin counties, while Mille Lacs, Morrison, Todd and Wadena lag in comparison with rates in the high 40s or early 50s.
“All these vaccines are scientifically proven to be extremely safe and effective. Essentially if you're vaccinated with any of the three vaccines your risk of being hospitalized, dying or having a severe illness with COVID is pretty close to zero,” Reese said.
“All these vaccines are scientifically proven to be extremely safe and effective. Essentially if you're vaccinated with any of the three vaccines your risk of being hospitalized, dying or having a severe illness with COVID is pretty close to zero."
— Dr. Jared Reese of Essentia Health
Albrecht said, “I think that people are starting to come around and they're coming in for their exams. … We're definitely seeing an uptick in our clinic visit volume and have plenty of people who have put things off that are trying to get back in right now.”
The good news is people are coming back, resuming their regular checkups and preventative care that was put on hold during the pandemic.
“That's kind of why we do those preventative visits, we want to try to identify potential health problems that we can deal with so they don't turn into a bigger problem down the road,” Reese said.