The Hidden Costs of COVID-19

Public Health Notes

By Catherine Colquitt, MD

This article was originally published in the March/April 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

In response to soaring overdose deaths across the U.S. during the pandemic, the American Medical Association (AMA) Advocacy Resource Center published a brief on Nov. 21, 2021, cataloging increased overdose deaths state-by-state. They decried decreased access to “evidence-based care for substance use disorder, chronic pain, and harm reduction services.”1

The AMA also sent a letter to the U.S. Centers for Disease Control and Prevention urging requirements for health insurers to eliminate barriers to opioid treatment for patients who would benefit from these therapies (think prior authorizations for prescriptions and faxed referrals for specialists). The letter also supported the Biden Administration’s 2022 National Drug Control Strategy, which highlights increased production of medications for substance use disorders, harm reduction strategies (including needle and syringe exchange programs), access to naloxone without prescription, and elimination of health insurer obstacles which prevent persons with chronic pain from accessing pain management.

In addition, a letter from AMA’s Dr. James Madara, MD, to Regina M. LaBelle, the acting director of the Office of National Drug Control Policy, on July 9, 2021, stated that healthcare inequities and social determinants of health fueling the overdose epidemic and disproportionately affecting the “marginalized and minoritized” must be addressed.2

The National Vital Statistics System recently released its “Provisional Drug Overdose Death Counts” for 2021 for the fifty states and the District of Columbia.4 The total overdoses will likely be revised upwards as case compilations for 2021 are completed and reports verified, but the provisional death toll is staggering. Over the 12-month period which ended in June 2021, overdose deaths rose from 47,523 to 98,022, and in Tarrant County, our overdose deaths mirror the national trend with 350 overdose deaths for the 12-month period ending March 2021, compared with 185 overdose deaths for the 12-month period ending January 2021. (Tarrant County data are not yet available for April – December 2021 on the NVSS dashboard.) 

Overdose deaths provide one measure of the toll of COVID-19 in the U.S. and expose need for redress of healthcare inequities, access to medication for opiate use disorders, substance use disorder treatment, mental healthcare access, and access to pain management. Another way the impact of COVID-19 is being assessed is through peer-reviewed publications exploring the hidden costs and benefits of conventional in-person (commuter) work versus work from home. 

“Over the 12-month period which ended in June 2021, overdose deaths rose from 47,523 to 98,022, and in Tarrant County, our overdose deaths mirror the national trend with 350 overdose deaths for the 12-month period ending March 2021, compared with 185 overdose deaths for the 12-month period ending January 2021.”

The results of such studies are uneven and the responses necessarily somewhat subjective when subjects are questioned regarding their feelings about in-person versus telework; in general, workers viewed telework more favorably when they volunteered for it and when their schedules included a combination of both in-person and telework. When mandatory, some teleworkers experienced increased “work-family conflict” as the lines between work and domestic life blurred during telework. Teleworkers and conventional in-person workers reported variable effects on depression, exhaustion, fatigue, and energy level.5

Using data from the American Time Use Survey, authors asked workers to record in a diary where they worked (whether they commuted or not) and noted that male teleworkers in this study reported lower pain, stress, and tiredness levels, but that there was no difference in these measures among female commuters versus non-commuters.6

In another study based on the American Time Use Survey, the designers compared pain in working-at-home versus conventional workers and found no difference in pain reporting between the two groups. However, working-at-home fathers reported increased stress and working-at-home mothers reported decreased happiness.7

COVID-19 is, at the very least, an engine powering academic inquiry, which may have unexpected future benefits for the way healthcare is delivered and work is done.  In the meantime, we must continue the important work of educating, advocating, and caring for our communities.

References
1. AMA Advocacy  Resource Center:  Issue brief: Nation’s drug-related overdose and death epidemic continues to worsen, Updated 11/12/2021 

2. AMA letter to Regina M. LaBelle, Acting Director of Office of National Drug Control Policy, 7/9/2021

3. AMA letter to the U.S. Centers for Disease Control and Prevention, June 2020

4. National Vital Statistics System Provisional Drug Overdose Death Counts – NVSS dashboard for current data, with final data when available from https://www.cdc.gov/nchc/nvss/mortality_public_use_data.htm

5. Oakman J et al. A rapid review of mental and physical health effects of working at home: how do we optimize health? BMC Public Health (2020) 20:1825

6. Song Y, Gao J. Does telework stress employees out? A study on working at home and subjective well-being for wage/salary workers J Happiness Stud 2019;21(7):2648-68

7.   Gimenez-Nadal JI, Molina JA, Velilla J. Work time and well-being for workers at home: evidence from the American Time Use Survey. Int J Manpow 2020; 41(2): 184-206

TCU Medical Students get unique first hand experience with latest laparoscopic technology

By Prescotte Stokes III

Originally published by TCU School of Medicine on April 19, 2022. You can read the original article here.

TCU School of Medicine welcomed experts from Olympus, global leaders in the development of medical devices, onto their campus in early February to give medical students an immersive and hands-on experience using the latest laparoscopic surgery equipment.

Jim Cox, M.D., an assistant professor at TCU School of Medicine, helped organize the event with the help of the Gastrointestinal and Hepatology Student Interest Group (SIG).

“When I was in private practice I worked extensively with Olympus and I reached out to a former colleague and asked could you provide this training session for the students,” Dr. Cox said. “The thing with Gastroenterology is that much of what we do is colonoscopy or upper endoscopy. We have first, second- and third-year medical students here just to give them the opportunity to see if they’re interested in Gastroenterology.”

Before immersing themselves into the technology, about two dozen medical students joined Dr. Cox for a brief presentation in the simulation lab. He gave a brief overview of typical things the students might see during residency.

“Let’s say an ulcer or a polyp or colon cancer and how are we going to treat those things,” said Dr. Cox. “Are we going to remove them? Are we going to remove an inanimate object from the esophagus that someone inadvertently swallowed? We’re talking about both urgent and non-urgent procedures that gastroenterologists encounter every single day.”

The medical schools’ simulation lab had laparoscopy training monitors and tools provided by Ethicon. The training monitors allow the students to see simulated examples of a laparoscopy, which are small scars on the abdomen. Students can use the monitors attached to the machine to practice suturing and knot tying techniques that require basic hand-and-eye coordination.

“This requires more than just being able to coordinate your hands,” said Sujata Ojha, a third-year medical student and co-president of the Gastroenterology and Hepatology Student Interest Group (SIG) at TCU School of Medicine. “There’s visual spatial movement and being able to know where you are in space and being able to maneuver without impacting the patients’ internal organs.”

Dr. Cox added that most of today’s gastrointestinal surgeries are done using a laparoscope, which makes this training much more beneficial for medical students.

“Most gallbladder, appendix and other intraabdominal organ removals are done using a laparoscope,” Dr. Cox said. “They leave very tiny scars which may actually go away in a few years as opposed to having the patient needing a big scar that could possibly stay for a lifetime.”

Gastroenterologists are advancing more and more into the use of laparoscopic procedures. A recent 5-year patient study presented at the 2022 International Gastric Cancer Congress in March showed  laparoscopy surgery compared with an open gastrectomy surgery was found to produce better overall survival outcomes for patients, according to the Cancer Network.

Mallory Thompson, a third-year medical student and co-president of the GI and Hepatology SIG, was excited about the demonstrations at the medical school.

“Medical students aren’t exposed to these kinds of medical procedures during their clinical rotations this is more for medical resident training,” Thompson said. “It’s exciting that our medical school faculty like Dr. Cox and our student interest group are setting up these kinds of opportunities for us.”

I’ve Done My Research

President’s Paragraph

by Shanna Combs, MD

This article was originally published in the March/April 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

“I’ve done my research.”

These can be some of the most dreaded words to hear as a physician from our patients and their families.  We can spend seven-plus years in medical school, residency, and sometimes fellowship, studying our field before we embark on our journey to practice medicine.  We also hone our craft through continued learning throughout our careers.  Yet, we are often confronted with the above phrase.  Since when did Dr. Google become such an expert that it can supersede our years of training and practice?

This became ever more apparent as the COVID-19 pandemic started over two years ago. (Yes, we have crossed over the two-year mark and are still counting).  With a lack of information and understanding of this novel virus as well as increased access to information on the internet, we in science and medicine saw people seeking out answers from all the resources they had access to.  This unfortunately led to propagation of numerous pieces of misinformation, distortions, and half-truths.  Add to this the politicization of our nation and the polarization regarding best measures on how to handle the COVID-19 pandemic, and unfortunately, we in science and medicine are left as the ones not to be trusted.

As a women’s health physician, I am confronted with this on an almost daily basis.  While the internet can be a valuable resource of information, it can also be a not so valuable resource of misinformation, lies, and myths.  Misinformation was commonly passed along in relation to women’s reproductive health even before the advent of the internet.  Unfortunately, nowadays it has a much wider reach with the “expertise” of Dr. Google to further spread these untruths.

What are we to do in this constant back and forth of the internet versus the doctor?

For me, I try to meet my patients and their families where they are.  I work with them to better understand where they are coming from as well as who or what their source of information is.  I cannot undo the vastness that is the internet and Dr. Google, but I can work to build a relationship with my patients and their families to come to shared decision making to provide the best care for them.  

For me, I try to meet my patients and their families where they are.  I work with them to better understand where they are coming from as well as who or what their source of information is.  I cannot undue the vastness that is the internet and Dr. Google, but I can work to build a relationship with my patients and their families to come to shared decision making to provide the best care for them. 

While this is helpful in individual encounters of patient care, I also feel that it is important for us as physicians to be out in the public arena as well. Because of this, I never turn down an opportunity to speak when asked, and I am always happy to provide my expertise for those in the media.  As physicians, we have a duty to educate. This is a responsibility not only to the individual patients we take care of, but also to the public. By offering education that is based in science and grounded in our years of continued study and experience, we can work to counteract the vast amount of distorted information that is out there.  I, for one, will continue in my efforts to dispel myth and spread truth.

HRSA Reopens Reporting Time for Period 1 Provider Relief Fund Recipients

Due largely to AMA and specialty society advocacy, the Health Resources and Services Administration (HRSA) has decided to reopen the reporting time for recipients of Period 1 Provider Relief Funds.

Those physicians who received more than $10,000 in provider relief funds and failed to submit their period 1 report should act immediately. Between Monday, April 11 and Friday, April 22, 2022, at 11:59 pm ET, physicians who have not submitted their Period 1 report may submit a late Reporting Period 1 report request. Physician practices should receive information about how to submit a request directly from HRSA via email.

If a physician did not submit a Period 1 report and does not hear from HRSA, they may initiate communication by calling (866) 569-3522. During this reopening period, the physician must choose an extenuating circumstance(s) that prevented compliance with the original reporting deadline. While attesting to an extenuating circumstance is required, no supporting document or proof is required.

If HRSA approves the extenuated circumstances form, the physician will receive a notification to proceed with completing the Reporting Period 1 report shortly thereafter. They will have 10 days from the notification receipt date to submit the late Period 1 report in the PRF Reporting Portal. 

Join TMA’s Virtual Career Fair

If you’re looking for the next invaluable member of your health care team, the Texas Medical Association offers opportunities for health care organizations to recruit physician and medical staff talent at its Virtual Career Fairs. The next Virtual Career Fair is on April 28, and spots are open for employers to exhibit. 

Here’s why you should exhibit at the next Virtual Career Fair: 

  1. Reach physicians and medical care professionals – TMA members and their teams are a ready-made pool of qualified professionals in a variety of specialties, locations, and career stages. TMA’s Virtual Career Fair offers employers exclusive access to this select group.
  2. Chat one on one with candidates in a virtual setting – Getting in front of busy physicians and other members of the health care team can be challenging. At the Virtual Career Fair, employers can meet directly with jobseekers at a specified time in a virtual setting. 
  3. Have a database of candidates to follow up with – All job-seeking participants create a profile and upload a resume to register for the fair. This means exhibitors can review potential candidates and follow up with specific individuals after the event. (Available for Gold sponsors only.)
  4. TMA 100% member practices receive 25% off exhibitor packages. 

Visit TMA’s Career Center for packages and pricing. To become a participating employer-exhibitor, visit the Career Center or email Lena Loomis.

Join Walk with a Doc on April 9th

Join our local chapter of Walk with a Doc this Saturday for a fun morning walking, talking about health, and meeting people in our community.

Here is what you need to know about the event:

• It will take place on April 9th, 2022
• The hour-long event will begin at 8:30am
• Walkers will start at LVTRise – 8201 Calmont Ave., Fort Worth, TX 76116

For more information, call Kate Russell, OMS-II, at 903-316-9392, or email her at KatherineRussell@my.unthsc.edu.

Join Project Access for a Lunch and Learn on April 20

Concerned about those in Tarrant County who go without healthcare or who are forced to get emergency care because they cannot afford necessary medical treatments? Consider joining Project Access Tarrant County’s Lunch and Learn on April 20 from 11:45 to 1pm. At this event, you will have the opportunity to:

  • Learn how we are making a difference for Tarrant County’s low-income uninsured residents
  • Hear from our staff, physician volunteers, and patients
  • See how we provide healthcare services for those in greatest need and how our new initiative will expand services

You can register for this free event here. It is targeted toward those who work in healthcare and everyone who is passionate about helping the underserved of our community.  

Project Access Tarrant County, which was founded in 2010, is a non-profit organization dedicated to expanding health care access and improving health outcomes for low-income, uninsured residents of Tarrant County, utilizing the charitable gifts of a network of existing voluntary providers and collaborative partnerships.

To date, Project Access has:

  • Scheduled 10,500 medical appointments
  • Enrolled over 2,100 patients
  • Provided over $18 million value in donated medical care
  • Performed 810 surgeries and hospital procedures

Their vision is for all Tarrant County residents to have access to a continuum of care, which includes specialty, pharmacy, laboratory, ancillary, and hospital care. Come on April 20 and see how you can partner with Project Access to bring healing and hope to those who most need it.

“I was falling into a hole of depression”

A Project Access Tarrant County patient story

By Allison Howard

“It was stressful knowing I was not going to make ends meet.”

When “Roberto,” a 49-year-old husband and father of two, began experiencing a burning pain in his torso from an inguinal hernia, he knew he needed to do something about it. Throughout the day it would grow in intensity, making it difficult for him to work. Roberto’s hours were cut, and he eventually had to take an entire month off of work.

“I could not do anything,” he says. “I was falling into a hole of depression.”

The family was experiencing tension from the economic burden, and it was impossible to consider surgery with the financial struggles they were facing day to day. Then, he went to Cornerstone Clinic, where he was referred to Project Access.

He was connected to Project Access volunteer and general surgeon Dr. Mohammad Siadati of North Texas Surgical Specialists, who agreed that surgery was necessary. Dr. Siadati performed the much-needed procedure at Texas Health Harris Methodist Hurst-Euless-Bedford, and anesthesia was provided by U.S. Anesthesia Partners.

“I am very thankful for Dr. Siadati, who was very attentive, respectful, and patient,” says Roberto. “I especially appreciated the patience Dr. Siadati showed when it came to the language barrier we had.” He thanks everyone who made his treatment possible, from those working the front desk to his doctor.

Since the surgery, Roberto has been improving steadily, and he was just cleared to return to work. He is optimistic about the future – he doesn’t feel stuck anymore in the cycle of pain and frustration. “It was a blessing, the entire process.”

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