The pandemic has upended the role of primary care providers in the US, but putting them at the heart of the vaccine rollout would help to restore their place, writes Eric Kutscher
As a primary care doctor in New York City, I’ve spent the past year unable to help my patients during the time they’ve needed me the most. As SARS-CoV-2 swept across the city last March, my outpatient office closed as I was redeployed to inpatient services to help care for those with covid-19 pneumonia. When I was finally able to see my regular patients again months later, I witnessed the pandemic’s toll on them: worsened control of diabetes, higher blood pressure, alarming problems with weight management, and devastating new cases of depression. I was pained by the loss of several of my patients to covid-19 itself, and bore witness to the suffering of those continuing to struggle with long term complications from their infection.
The pandemic has upended the ways primary care providers like me are able to routinely care for our patients. Many primary care offices across the US have shuttered due to the risk of covid-19 transmission to providers and office staff, decreased patient interest in seeking “non-essential” medical care, and difficulty with reimbursements for telemedicine visits compared with in-person visits. It’s ironic that while research has unequivocally shown covid-19 causes worse outcomes in people with pre-existing conditions like diabetes and hypertension, our singular focus on managing the virus has allowed for the worsening of these conditions, and increased the risk of morbidity and mortality among those infected.
When the Pfizer-BioNTech and Moderna covid-19 vaccines first became available here in New York, I tried to help my eligible patients secure appointments. Yet my patients and I were frustrated by hours of waiting on hold, a decentralized patchwork of websites, limited appointment availability at nearby sites, and last minute cancelations due to supply shortages. This life saving shot still remained mostly out of reach for my patients. In the meantime, I had to hold off on prescribing all other vaccines for healthcare maintenance, as individuals are not allowed to have received another shot within two weeks of their covid-19 vaccine—if they have, they are often deemed ineligible.
The US should return covid-19 care to primary care providers. And the Johnson & Johnson vaccine, which has been recently approved by the US Food and Drug Administration, is the perfect vaccine to do just that. It’s a single shot, and doesn’t require special storage temperatures—unlike the vaccines from Pfizer-BioNTech and Moderna. The vaccine can therefore be easily distributed at almost any primary care clinic nationwide.
Having a tool to help protect my patients from covid-19 will help re-engage them in other areas of their care: those who are looking for a vaccine will return to clinics for an appointment, and can get overdue refills for medications and manage their chronic medical problems. Vaccine distribution through primary care providers will help invest in our pre-existing structures for healthcare, rather than bypass them. And, as the likelihood of an annual booster shot for covid-19 becomes more of a reality, incorporating covid-19 vaccination into the site where all other vaccinations occur is the logical next step.
It’s time we move away from covid-19 exceptionalism where this novel viral phenomenon is treated separately from the remainder of medicine. Covid-19 has been here for a year—and for the foreseeable future, it’s here to stay. To best manage covid-19, we must integrate prevention and treatment efforts into primary care. A holistic approach to health and investment in our medical system is long overdue.
Competing interests: none declared.