Amid the Pandemic, Continuing Care for Everything Else
In the early days of the pandemic, people who did not have COVID-19 weighed the benefit of going to the doctor for a real issue, against the risk of catching the virus – such as from another patient in the waiting room.
One of them was Maryland Del. Anne Healey (D-Prince George's County), who took steps over the spring and summer that led to early detection of breast cancer, for which she was treated at the University of Maryland Greenebaum Comprehensive Cancer Center (UMGCCC) at University of Maryland Medical Center (UMMC).
"I do want to encourage the public, especially women, not to delay getting their regular medical treatment," Healey said. "Because if I had delayed it, my cancer might have grown to where they couldn't do as much for it."
Since 2015, when her sister and brother were both treated for cancer, Healey has been vigilant about cancer screening and regular check-ups. She went in for her annual screening mammogram in May 2020 at a local radiology provider, referred directly by her gynecologist without having to go in for an office visit beforehand. The results came back normal.
But about a month later, Healey discovered a lump in her breast and went to her gynecologist, who ordered an ultrasound, then a biopsy. It was positive for cancer. She got this news on July 31, late in the day on a Friday, from the radiologist. Rather than wait until Tuesday, as planned, to talk with her gynecologist to discuss next steps, she immediately got on the phone to call former colleagues who now work at University of Maryland Medical System (UMMS). They forwarded her name and number to the cancer center coordinators.
By early Monday morning, UMGCCC team members called Healey to schedule a one-stop visit for August 5, during which she met with a surgeon, an oncologist and a radiation oncologist – all faculty members at the University of Maryland School of Medicine. They had her mammogram and her records, and were ready to recommend a treatment plan.
During this meeting, the doctors piped in via speaker-phone Healey's sister-in-law, a surgical nurse in Florida who is the go-to health care adviser in the family. Healey knew the visit could be overwhelming. She wanted her sister-in-law to hear the doctors firsthand, so she could help Healey make decisions later.
After surgery and four rounds of chemotherapy, Healey started radiation treatment in January – when she also turned 70 and started her 30th legislative session in the Maryland General Assembly. In February, after a four-week course of radiation therapy, she rang the celebratory bell that can be heard throughout the lobby of UMMC when any patient finishes radiation therapy.
"It's been scary, I have to admit that. But I'm back now and feeling stronger," she said.
On January 8, 2021, The Washington Post published an interviewed with her.
"At first, I didn't want to tell anybody – I just wanted to deal with it as best as I could," she said. "It was after I finished chemo that I decided to go public so that someone else could have the benefit of my experience. When you're sick, it's just natural to focus on yourself and how to get well. Taking a step out like that was very liberating. It got me out of my own head."
She said House Speaker Adrienne Jones' staff have taken "extraordinary measures" to make the House Chamber safe for delegates to avoid COVID-19 transmission. She is also able to do much of her committee work virtually.
Bringing Patients in for Mammograms
Mammograms and Pap smears, which screen for cervical cancer, were down nearly 80 percent in April 2020 compared with a year earlier, a study by the nonprofit independent Health Care Cost Institute found. Colonoscopies, which screen for colon cancer, dropped nearly 90 percent.
"Screening mammograms save lives by detecting breast cancer early when it is more easily treated," said Katherine H.R. Tkaczuk, MD, professor of medicine and director of the Breast Evaluation and Treatment Program at UMGCCC. "We want to assure women that having a mammogram now is safe and urge them not to delay having their regularly scheduled exams because of COVID-19."
UMMS released a public service announcement: "Don't Forget to Get Your Annual Mammogram." The announcement was uploaded onto the UMMS YouTube channel.
Telemedicine Visits Soar
Use of telemedicine spiked across the system, from 473 telemedicine visits during February 2020 (pre-pandemic) to 42,133 telemedicine visits during May 2020. Between March 1, 2020, and March 1, 2021, UMMS conducted 327,651 telemedicine visits.
UMMS physicians were using telemedicine to a degree before the pandemic, so the sudden need to use it widely required a rapid and intense effort. Clinical team members learned how to guide patients through the technology while ensuring patient privacy.
Many service lines have adopted the use of telehealth, scheduling video conferences with patients when in-person visits are put on hold.
During visits, providers can address any new health concerns. If patients require medication, providers send electronic prescription orders to patients' pharmacies. If a patient requires in-person care, telehealth gives providers the opportunity to recommend it.
"Our stroke team continued to provide up-close, high-acuity care for stroke patients during the pandemic," said Peter B. Crino, MD, PhD, professor and chair of neurology. "They persevered, continuing to see patients even at risk to themselves and keeping this vital clinical service alive."
When Care Couldn't Wait
While UMMS physicians, nurse practitioners and physician assistants provided telehealth alternatives to in-person care during the pandemic, some health concerns required hands-on treatment. Clinicians at UMMS worked to provide emergency patients with the care they needed.
UM St. Joseph Medical Center cardiologist Jeremy Pollock, MD, appeared on local television along with UMMC cardiologist Mark Vesely, MD, associate professor of medicine, to offer assurance and advice for people with heart conditions and for those at risk for heart attack and stroke. Their message was clear: Do not delay.
- Learn more about when to go to the hospital.
Behavioral Care – More Important Than Ever
Recent studies show that four times as many adults report symptoms of anxiety or depression compared to before the pandemic, with young adults especially at risk for substance use and suicidal thoughts.
So it was more important than ever to ensure that patients were able to access care through telehealth, and in person if needed.
"Stress reactions, increased anxiety and depressive symptoms have become common during the pandemic, as are exacerbations of symptoms of pre-existing behavioral health conditions," said Constance Noll, DNP, CRNP, PMHNP-C, psychiatric nurse practitioner at UM Upper Chesapeake Health.
Noll uses telehealth to care for patients who are unable to visit her in person.
"It is important for the public to know that they are not alone and that help is available for those who reach out," said Noll. "Telehealth takes a little adjustment, as it is different than in an in-person visit. However, just as using Zoom with family is a way to achieve connection, so is telehealth."
Treatment can include reminding patients that their grief and negative feelings are a normal reaction to the challenges of the pandemic, and that they can transform anxiety and fear into new levels of functionality.
Learn more about caring for your mental health in a pandemic.