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With the COVID-19 pandemic in the local area now approaching the four-month mark, the Sun Gazette asked leaders of the Arlington County Medical Society for an update – and sought their thoughts on how the pandemic’s impact is likely to change health care and, potentially, society.

“Members of our medical society will have different perspectives based on their own working environment,” said Donald Saroff, MD, an orthopaedic surgeon and president of the Arlington County Medical Society.

“Like the people who comprise our society, this recent issue is complex and has many facets,” he told the Sun Gazette. “Some of our members are in private practice, some are employees of hospitals and others are employees of large managed-care organizations. Some of our docs are specialists, some are generalists. Some are on the ‘front lines’ and some are not. Some of our docs’ practices are heavily procedure and patient-contact based, some are not.”

Among those taking part in the Q&A:

• David Lee, MD (anesthesiology), Virginia Hospital Center medical staff president; past president and membership chair of the Arlington County Medical Society.

• Paula Bergamini, MD (internal medicine), Arlington County Medical Society legislative committee chair and past president.

• Marla Kelly, MD (OB/GYN), Arlington County Medical Society treasurer.

• Edward G. Koch, MD (OB/GYN), Arlington County Medical Society past president.

What are you hearing about how much advance warning the local medical community had in terms of the scope and severity of the pandemic, and how challenging was it for the medical community as a whole during the earliest period it hit the local area?

Dr. Lee: The medical community had very little warning of the coming pandemic.  Most of the early information was garnered by reading news stories and by anyone who had friends living in China, Seattle and New York. The problem with COVID was that not only did it affect our patient population, there was fear and uncertainty within the medical community about protecting other patients and staff from infection.

Dr. Kelly: I believe that the initial belief was NOT that the coronavirus was more serious than the flu.  Unfortunately, we quickly learned that the death rate was higher.  Fortunately, the Mid-Atlantic Permanente Medical Group pivoted quickly to provide testing, virtual visits and home delivery of many medicines. While all of this was done before the COVID-19 crisis, it was increased exponentially because of it.

Have you seen significant increases in public-health issues that could be described as related to the shutdown of daily life, from depression to domestic violence to issues that developed because of a lack of routine care or an unwillingness to go to a medical provider?

Dr. Bergamini: From early, on the mental-health impact of the pandemic was forefront. We saw a sharp increase in patient requests for sleeping aides and anti-anxiety medications, and as time went on significant relapses of depression with and without psychotic features. Early on, at least half of virtual visits were spent attempting address patients’ anxiety in a constructive way.

I initially had some concerns about surges in antibiotic resistance, due to an increase in empiric treatment of respiratory infections during the last part of the winter. However, due to the shutdown, there were clearly fewer respiratory infections, since many families were home.

Dr. Lee: It is curious that, pre-COVID, hospitals were filled beyond capacity, but during COVID shutdown and now after easing some restrictions, patients seem to be neglecting routine, less urgent medical care.

With non-scheduled (elective) surgery off the table for a period of time during the pandemic, and in-person routine visits with patients often curtailed, what kind of challenges were posed to medical professionals who weren’t directly on the front lines in tackling COVID-19? How significant an economic impact are some of your members reporting?

Dr. Lee: COVID cases were ramping up, hospitals and elective surgeries were shut down. Hospitals were busy trying to contain and treat the epidemic as other areas of the hospital were shut down. The overall census of the hospital fell, but the COVID patients were coming in fast and the ones coming to the hospital were very sick and often in need of oxygen and critical care, ICU, intubations, ventilators, sepsis, dialysis, and constant attention.

Because actual hospital and office volumes were down significantly, economic losses were heavy for most physicians and hospitals.

Dr. Kelly: My group is faring well as a result of our model of care (a non-fee-for-service model).

What changes in procedures and protocols do you think the public should expect will be made permanent even as we move out of the pandemic?

Dr. Lee: COVID is here to stay.  No easy cures or fixes will arrive in the near future.  The new reality is that we must practice good safe hygiene with frequent handwashing, wearing masks and social distancing.  There is no cure in sight and vaccine development, although hopeful, may not be the panacea to fix all the issues with this disease.

Dr. Koch: Tele-health has become a valuable tool for both the patient and the physician. Once the patient-physician relationship is established, care can be managed in many circumstances by telephone or “virtual” visits. Currently, Medicare and the insurance companies are paying for this service. Hopefully, the health-insurance industry will realize what a valuable tool this modality represents for the care of the patient.

Dr. Kelly: A form of social-distancing will likely persist, as recommended by the CDC. Additionally, there will be more investment in zoonoticàhuman infection and vaccine manufacturing.

Dr. Bergamini: I think that patients will be a bit more comfortable utilizing “virtual” visits when they are appropriate. That will definitely stay after the pandemic. Perhaps everyone’s greater understanding of herd immunity will encourage greater compliance with routine influenza vaccination.

What’s your biggest concern going forward, and what is the biggest reason for optimism you see?

Dr. Lee: The biggest concern is that we do not treat this disease seriously and become complacent.  Sure, we can’t live our lives in fear, and we can’t always be shut down, but there are common-sense steps that can be taken to lessen its impact.

We have faced pandemics before (Spanish flu, HIV, ebola, measles, smallpox, polio) and we are likely to face future epidemics, but each time – through science, medicine and common sense – we were and are able to overcome.  Simple steps of hygiene, social distancing and wearing masks will improve our situation until more definitive treatments and vaccines are produced.

Dr. Kelly: I believe that this moment is a huge inflection point for medicine and medical equity/justice.  I look forward to the legislation that will be created from this moment that will affect generations to come. 

Dr. Bergamini: The biggest concern going forward is that we learn nothing from this. There are communities at risk that could have benefited from some targeted interventions early on and I am hoping we remember that in the fall, let alone in future years.

And do I dare say that a single-payer healthcare system may have made our national response more efficient?  I look forward to more global analysis of this question in years to come.

How has the current situation impacted the Arlington County Medical Society?

Michelle Saroff, executive director: As a medical society that provides networking events and educational meetings for our physician members, the COVID-19 pandemic has impacted much of how we work and connect with (and within) our members and community.

During the strict social-distancing measures, Arlington County Medical Society, like so many other organizations, switched to various digital platforms to communicate, coordinate and stay connected – as it became clear that communication and sharing of information specific to healthcare workers and their needs in this novel pandemic are what our members needed most (besides up-to-date information on new COVID-19 developments).

We also created “Project Gratitude” as a way to involve the participation of our community (artwork/messages to be installed at local hospitals and to be shared digitally) – expressing gratitude, awareness to the risks and hard work of our local healthcare professionals and an opportunity to educate our younger population who were staying at home.

The results were stunning and touching. Many of the artists/authors were children of physicians, who knew firsthand the risks involved in having a parent working on the frontlines. Submissions came from our local community as well as from around the world, expressing a truly global gratitude towards medical professionals.

We all watched with sadness as our local high-school seniors lost their graduating ceremonies, internship opportunities, and career-day experiences. Though our fundraising activities were put on hold this year, ACMS Foundation moved forward to donate a $10,000 scholarship to Wakefield High School, to be awarded to a graduating senior who plans to study medicine or health care.

We continue to monitor the situation, communicate and support our members and community.

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