番茄社区

For 番茄社区's "After the Pandemic" series, we asked our to discuss what significant and lasting effects the COVID-19 pandemic will have on medicine and the delivery of healthcare.

Here, we interview Edwin Leap, MD, an emergency medicine physician and writer. Dr. Leap has a special interest in rural emergency care and physician advocacy, and is a locum tenens physician in South Carolina.

Check out some of our other articles in the series here.

Can you share an anecdote about a patient of yours, de-identified of course, and how the pandemic influenced their situation? What was the outcome?

Leap: I saw a patient who was in the emergency department for something vague. She was a 40-year-old woman who was very upset because she had a severe case of COVID several months ago and was absolutely convinced that she had been infected again. And yet, nothing really suggested that. She had no fever, no cough, no shortness of breath. She still had some persistent weakness, but was going on with life. She was nevertheless a wreck: tearful and afraid. I said to her, "Look, I understand your fear but it's unlikely you will contract it again. Furthermore, you are a survivor! You had it and you pulled through. Remember that!" She smiled and thanked me.

I believe that as bad as the disease is, the fear associated with it is pretty devastating as well. We need to be careful in our messaging. We needn't dismiss COVID in the process of giving our patients hope that all will be well.

Give us a sense of how the pandemic unfolded in your rural practice, and how you think that differs from what you saw in the media about how it played out in the cities?

Leap: In the area where I work in South Carolina, there was an initial outbreak in a local casino. The casino shut down and the cases dropped. But while there were some very tragic situations and certainly deaths, it didn't begin to approach the devastation of large urban areas. Why is that? I suspect it's likely due to the inherent "social distancing" of rural life. When your neighbor is a quarter or half a mile away, it's easier to avoid interactions.

In a rather silly bit of reportage, a major news source during the pandemic was using cell phone data to point out that the rural masses were leaving their homes far too often and likely spreading the disease. However, rural individuals have to leave home and drive to simply go to the grocery store! It was not reflective of poor choices, but daily necessities.

What are the reasons that your community wasn't as affected by the virus -- just population density, or do you think there were other factors?

Leap: Yes, the population density of rural America is quite low compared with urban areas. And mass transit doesn't really exist. So the ways that COVID and other viruses pass through the population just weren't factors to the same degree.

It could also be that people who are in rural areas are often outside more -- due to work, hobbies, or just normal home life. In the process, they are active and also raising vitamin D levels from sunlight exposure. Many in urban areas were fearful of even going outside and did not have the same advantage.

Of course, there were still gatherings in rural areas, and even as schools shut down, some churches still met. This was one of the few large-crowd settings available and, indeed, sometimes there were infections. But many churches also employed measures to mitigate the virus, such as multiple services with fewer worshippers, use of masks, and holding virtual worship (not always possible with the simply awful rural internet connections many of us face).

Another interesting factor is that while the media went on and on about ignorance and noncompliance, the patients and families I met were extraordinarily diligent about masks and gatherings, visiting elderly family members, and even shopping. It's unfair to paint rural individuals as unwilling to follow guidelines when so many did, and so well.

What do you think will be the long-lasting implications of the pandemic for your practice? Will any aspects be forever changed, whether for the worse or the better?

Leap: The long-lasting effects of the pandemic on my practice? Certainly I'll be attuned to the transmission of infectious diseases. I was never really a person who wore a mask during flu season. I suspect I'll be looking around the CDC and WHO sites now to see what's on the horizon.

However, perhaps most powerfully, I'll remember how important it is for us not to let politics into practice. And I don't mean "patients need to stay out of it and listen to us." I mean, physicians became terribly nasty and political and said awful things like "if you don't listen to guidelines, you shouldn't be treated," and referred to people who didn't mask as "covidiots." This sort of thing is unproductive.

I think I understood this, but moving forward I'll try harder to be attuned to the fact that many of my patients don't, or aren't really capable of, understanding scientific data. And they need me to help them. But for that to work, they need to trust me and know that I don't disdain them, that I don't view them as backwards or stupid because they may not want to do what I say. We always knew that people needed to trust us to do what we thought was right. The pandemic has made that clearer than ever. At least to this physician.

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