key: cord-0825300-m8sgczgd
authors: Reeves, Geri C.; Holley, Sharon; Keilman, Linda J.; Reyes, Imelda
title: Preface: Primary Care during COVID-19 and Beyond
date: 2021-02-15
journal: nan
DOI: 10.1016/j.yfpn.2021.02.006
sha: ded47f97e9a76da5504b88e7884ab10fb4e7b507
doc_id: 825300
cord_uid: m8sgczgd

nan

The novel coronavirus outbreak was declared a public health emergency of international concern on January 30, 2020. As of this writing, on October 19, 2020, there have been 39, 944, 882 confirmed cases of COVID-19 worldwide with 1,111, 998 confirmed deaths globally 1 . In the United States (U.S.) 8, 393, 773 people have contracted the virus and there are 224, 824 confirmed deaths 2 . These staggering statistics represent the worse pandemic in modern times. The current COVID-19 pandemic taught us important lessons about how primary care (PC) can respond during a pandemic. The role of PC as the first point of contact to the healthcare system should not change during a pandemic. As the first line of defense, PC has the potential to reinforce critical public health messages, help patients manage infections at home, and identify those in need of inpatient care 3 . Done well, this can reduce the spread of infection and protect hospitals from being overwhelmed 3 . Yet, the realities of a fragmented healthcare system became evident during the COVID-19 pandemic.

PC practices can adapt and continue to reinvent themselves during a pandemic using the Center for Disease Control's pandemic framework recommended actions. The core principle is protecting clinicians, staff, and patients while remaining available and connected to meet patient needs 3 . Yet, in response to the COVID-19 pandemic, practices struggled to rapidly adapt to demands. Testing was not available and contact tracing not possible. As the pandemic spread, many practices converted to virtual care using telehealth 3, 4 . Though not commonly tested in disaster settings, telemedicine was a crucial component of the medical response to COVID-19 by reducing demand on strained healthcare infrastructure and enabling health care needs to be met at home while reducing exposure for patients and healthcare staff. In fact, the widespread adoption of telemedicine associated with the COVID-19 pandemic was unprecedented and will likely have a significant and durable impact on health care delivery 4 .

The current pandemic also made the need for access to affordable care to all painfully clear. Well known social determinants of health, such as educational attainment, occupation, place of residence, access to affordable and healthy food, and race or ethnicity, are key factors that influence one's ability to safely weather a global pandemic of a highly infectious disease 5 . What is more, approximately half of Americans receive health coverage through their employer, and with high numbers filing for unemployment insurance, millions find themselves without health insurance during the largest pandemic in a century 6 . Failure to receive testing and treatment because of cost harms everyone by prolonging the pandemic, increasing its morbidity and mortality, and worsening its economic impact 6 .

To address numerous issues raised by COVID-19, the U.S. Congress has passed two significant pieces of legislation. The Families First Coronavirus Response Act (FFCRA) requires all private insurers, Medicare, Medicare Advantage, and Medic-aid to cover COVID-19 testing and eliminate all cost sharing. It also appropriated $1 billion for the Public Health and Social Services Emergency Fund to cover testing for uninsured individuals under state Medicaid plans. These laws provide critical assistance. However, additional policies are needed to ensure that Americans can continue to access affordable care as the crisis continues and beyond 6 . Policy makers and payers must ensure that funding and policies allow PC to transform and adapt to COVID-19's impact on our nation's healthcare system. The health and well-being of all Americans depends on it. As PC providers you are uniquely qualified to advocate for policies and funding that protect clinicians, staff, and patients. We must continue to call on our nation's leaders to address the needs of PC during the current pandemic and beyond.

To further support PC practices in providing healthcare needs, you will find in this issue of Advances in Family Practice Nursing, information on infectious disease prevention, older adults and driving cessation, diagnosis and management of obstructive sleep apnea, management of constipation in older adults, dementia, evidence based care for pregnancy complicated by obesity, smoking and maternal health, screening and treatment for genitourinary syndrome of menopause, updates on pap guidelines, mammogram screening, pharmacology in pediatrics, and sports medicine. We trust that this issue will provide timely and relevant information that will support the management of your patients.

World Health Organization. Coronavirus disease (COVID-19

United States COVID-19 Cases and Deaths by State

Redesigning primary care to address the COVID-19 pandemic during the pandemic

Patient satisfaction with telemedicine during the COVID-19 pandemic: retrospective cohort study

An opportunity to emphasize equity, social determinants, and prevention in primary care

Covid-19and the need for health care reform

List the full name and degrees of each Guest Editor exactly as they should appear in print