KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5. Welcome. In a year when hospitals were overwhelmed with COVID-19 patients, other kinds of medical care decreased significantly. Many put off their yearly screenings and check-ups and deferred treatments for cancer and other illnesses amid the pandemic. So, what are the causes and consequences of delaying healthcare? Joining us now is Emma Court who is a Health Reporter at Bloomberg News. Emma, thank you very much for joining us.

EMMA COURTThank you so much for having me.

NNAMDIYou wrote a story this month about the harmful and costly effects of delaying medical care. What did you find in your reporting?

COURTYeah. So, something I was very curious about, I'm a Healthcare Reporter and I've been covering this pandemic since its earliest days. And had been curious for a long time about -- we kept hearing about how hospitals were canceling scheduled procedures in order to free up space in case they have a kind of a flood of COVID patients coming in. Wanting to make sure they had the resources and the facilities to treat those COVID patients. And it's something I've been tracking for a long time wondering, well, what about all those other patients, who had these scheduled procedures, you know, whether it's something really kind of needing immediate care like a cancer procedure or something that's sort of elective, but you could imagine putting off maybe a hip replacement and having pain and having complications and things like that.

COURTSo, it's something I've been tracking for a long time, and we decided to do this big picture look kind of looking at different dimensions of this. What does it mean for patients? What does it mean for the cost of U.S. healthcare, which is sort of notoriously higher than in many other countries?

NNAMDIWhat are some of the reasons for what you found to be a decline in regular check-ups and procedures?

COURTRight. So, I think we can all kind of think back to those early months of the pandemic last year when people really didn't know what was going on and there was a lot of confusion. There was a lot of fear in particular. People were being told to stay home. And they were also being told that they could get COVID at the hospital. And they were afraid of getting infected. So, in those early months there was perhaps the most dramatic decline in care. If you look at these charts, I mean, it just kind of went off a cliff. And then over time you do see people ended up kind of going back. Not just to the hospital for other reasons. But also in-person to doctors' offices a little bit more.

NNAMDIEmma, it's not just that people were making a choice to forgo medical care in the first few months of the pandemic. Many were apparently simply unable to access proper healthcare. What did you find?

COURTRight. So, another dimension of this issue is that I think many of us found our appointments were canceled, right? Physicians' offices had to adapt to a pandemic just like everyone else. And they needed protective equipment that was hard to find. Maybe they had moved over to doing telemedicine appointments and weren't necessarily accepting in-person care. And so, this is a big factor that shaped when people -- even if people were trying to get back in to see their physician for something, they wanted the physician to look at, you know, in-person, they weren't always able to especially in those early months.

COURTAnd even in the months since, because as you can imagine thinking of those pre-pandemic crowded doctors' waiting rooms. Doctors are trying to also make sure people are able to social distance and things like that in the waiting room. And so, there are fewer appointment slots than there used to be. And that does affect your ability to get in and get treated.

NNAMDIJoining us now is Dr. Bill Borden, Cardiologist and Chief Quality and Population Health Officer at George Washington Medical Faculty Associates. Dr. Borden, thank you for joining us.

DR. BILL BORDENGood afternoon. Thanks for having me.

NNAMDITell us. What has this last year been like for you?

BORDENWell, you know, I'll tell you this sort of unprecedented and unimaginable news this week that we've crossed over 500,000 deaths in the U.S. and certainly much more globally. I mean, the pandemic is just devastating. As I think about the lives cut short and just the ripple wave effects on family members, friends, communities, it's just really devastating. I can tell you that early in the pandemic I lost a friend to COVID. And, you know, that really hit home for me. And, you know, I've spent this year like all of us keeping safe, keeping my family safe, navigating these challenges.

BORDENAnd then in my role at GW, I've made sure that we're able to treat both our patients with COVID-19 and those with non-COVID conditions. And through all that, you know, keeping our healthcare workers safe. And I'll just say it was really a powerful moment for me in sort of mid-December when our first vaccines arrived early on a Monday morning.

BORDENAnd, you know, as we were opening that box and seeing that cold mist sort of coming out the box, I have to say I got teary eyed as I thought about the tremendous loss, the economic toll, the worsening of long standing racial disparities, the importance of public health interventions, you know, the tremendous strength of our healthcare and the resilience of our community. And then the power of science to really quickly bring forward these safe and effective vaccines, which I really do think is our path forward out of this pandemic and our return to normal.

NNAMDIA lot of people have put off doctor's appointments, screenings and check-ups this past year. What are the consequences when people miss regular visits with their doctor?

BORDENWell, I'll tell you going back even to February of last year that was a real concern of ours, because when people avoid getting care they risk getting sicker and dying. And, you know, in the U.S. in this pasts year we saw 20 percent more deaths than what would have been normally been seen. And about one out of five of those seem to be from non-COVID reasons so dying from other conditions.

BORDENAnd this is really kind of in three categories. So, it's emergent care, so people not going to the Emergency Room for something like a heart attack or stroke. And there were studies that showed that heart attack visits to the Emergency Room went down by about 40 percent. And a more recent study was showing that more people are actually dying from heart attacks during this time period. The second area is sort of chronic diseases. So, diseases like diabetes, asthma, high blood pressure.

BORDENAnd so, when people don't or aren't able to get access to care for those conditions, those conditions worsen. And during the pandemic we saw deaths from something like diabetes being 15 percent greater than normal. And then lastly is the preventive care. And, you know, screening for cancer or high cholesterol and, you know, if that's left undone that could lead to disease that could otherwise be avoided. And in fact, there's one recent study, which showed that breast cancer, colon cancer and cervical cancer screenings were all decreased in this past year.

NNAMDIWe're talking about delaying healthcare, because of fear of COVID or because one is not able to get appointments. And Debbie in Greenbelt emails, "I understand the priority is COVID. However, people waiting for other procedures are in pain. My brother needs a knee surgery and continues trying to do daily tasks while he awaits surgery. Something needs to be done. Medical attention is waning." And now here is Nina in Columbia, Maryland. Nina, you're on the air. Go ahead, please.

NINAHi, thanks, Kojo, very much. I'm so glad you're doing this today. You know, early on I know it was very heightened and it was very, you know, everybody was very anxious. And I remember calling my physician many times to be seen. And each time he just said, no, I can only do a video visit, and I knew something was wrong. And I ended up having to go to another healthcare provider and pay only to find out I had bronchitis, but he refused. Kaiser would not see me. They would only do video visits.

NNAMDIDid you do any video visits? Did you do any tele-visits?

NINAI did one initially and I told him, listen, I know something is wrong. And so, I ended up having to go Patient First, because I have a friend there who was a doctor. And he said, I'm glad you came in. You have bronchitis. And I had to be been seen. I could only go to Patient First, because early on in the pandemic Kaiser literally -- their doctors out here in Columbia, they weren't seeing anybody.

NINANow here's the other thing. He never said, you can go to urgent in South Baltimore. That's one thing. The second thing I want to tell you I had a cousin recently die who thought he had been battling a sinus infection. Turned out it was his heart. He went to a hospital in -- I'm not going to say, which one in D.C., very good one, and ended up dying from an infection in the hospital.

NNAMDIWhat a story. Thank you very much Nina for sharing those stories with us. Dr. Borden, you specialize in preventive cardiology. How have your patients been impacted by the pandemic? You just heard what Nina had to say.

BORDENAbsolutely. And I'm sorry to hear about cases where people weren't able to access care. You know, certainly in those couple of weeks we as well as many doctors and providers shifted to providing telehealth. But, you know, we remained open throughout. And I can tell as soon as we could in the springtime reopened to offering our full range of services. And I think it's been really important for my patients, because they are looking not only to manage their heart disease, but also to prevent it.

BORDENAnd some of those visits are very appropriate for telehealth. So, when I'm meeting with a patient to talk about, you know, diet or exercise, lifestyle interventions. That can be a good fit for telehealth if the patient feels comfortable with it. But it's always an option for an in-person visit. And for some things like someone who is having chest pain or shortness of breath then that in-person visit really makes much more sense so that I can do a physical exam. We can get an EKG and make sure that the person gets the treatment appropriately that they need.

NNAMDIYou heard Nina's other concern about somebody who went to the hospital and got infected. How safe is it to go to a hospital, clinic or doctor's officer right now? We only have about a minute left in this segment.

BORDENSure. It is safe. I can definitely and confidently say that it is safe to go to the hospital. It is safe to go to your doctor's office. They're following the safety measures. And I think the key message is do not delay care for concern of getting COVID-19.

NNAMDII'm Kojo Nnamdi.

NNAMDIWelcome back. We're talking about delaying healthcare as a result of the pandemic. We're talking with Emma Court, a Health Reporter at Bloomberg News. Dr. Bill Borden is a Cardiologist and Chief Quality and Population Health Officer at George Washington Medical Faculty Associates. And I think I better bring in our other guest now, because we're getting a lot of calls and they might be able to answer some of these questions. Meet Dr. Edwin Chapman, an Internal Medicine and Addiction Medicine Specialist. Dr. Chapman, thank you for joining us.

DR. EDWIN CHAPMANAnd thank you for having me, Kojo.

NNAMDIAnd Dr. John Marshall is Chief of Hematology and Oncology at MedStar Georgetown University Hospital. He co-authored a book with his wife Liza called "Off our Chest," an inside look at the world of cancer care giving. That book comes out April 6th. Dr. Marshall, thank you for joining us.

DR. JOHN MARSHALLKojo, it's an honor. And really thank you for bringing this up. This is a big subject.

NNAMDIIndeed. Let's go to Charles in Columbia, Maryland. Charles, you're on the air. Go ahead, please.

CHARLESHey, can you hear me okay?

NNAMDIYes, we can.

CHARLESExcellent. So, at the end of the year, I had a heart related event and there was really no question in my mind that I needed to go see a doctor and get everything checked out. And everything was fine. But I think that some of those decisions comes down to, you know, our personal circumstances, insurance and having the time and then weighing the odds of COVID and how bad we think COVID might really be versus the thing we think we're experiencing. And so, I think the education about COVID really plays a factor in that decision.

NNAMDIThank you for sharing that with us, Charles. Dr. Borden, there have been reports that fewer Americans are going to the hospital for heart attacks choosing instead to ride them out at home. What happens when someone having a heart attack just does not go to the hospital?

BORDENYeah, it's a great question. And it's something that keeps me up at night as I worry about that. You know, a heart attack is basically when the heart doesn't get enough blood flow and part of the heart dies. And the worst case scenario if someone stays at home and doesn't get treatment is that person can die from the heart attack. You know, otherwise they can get sicker. They can develop something called heart failure where the heart doesn't pump as well or develop abnormal heart rhythms, which it in itself could lead to death.

BORDENThe good news is is that heart attacks are treatable nowadays both with the initial heart attack we have phenomenal treatments that can really help people. And even for some of these conditions like heart failure, abnormal heart rhythms. We do have treatments available. I think the key thing is just to get treatment. And if someone is having chest pain or concerns of a heart attack to call 911 and get into the Emergency Room.

NNAMDIHere is Cassie in Reston, Virginia. Cassie, you're on the air. Go ahead, please.

CASSIEHi, Kojo. Yeah. I wanted to raise concern with how hard it is to already get healthcare being an LGBT youth. And then with everything on top with the coronavirus it's hard to go into the doctor's office and get the correct medicine and hormone treatments that I need to, you know, be able to properly function and stuff like that. And COVID has just made it harder than it already is to be a part of that.

NNAMDIHave you been able to do that at all, though?

CASSIEI have been able to it some. A lot of it is virtual, which is really hard to be able to go in and connect with the doctor. But a lot of times it's just really hard doing virtual stuff and being able to get the correct care you need and find the right doctor.

NNAMDIThank you very much for your call. Emma, you wrote about how U.S. consumer spending on healthcare dropped for the first time in 60 years. What are some of the reasons for that?

COURTYeah. That was a pretty major development during the pandemic, because typically U.S. consumer spending on healthcare increases kind of month after month year after year. So that kind of speaks a bit to just how profound that early disruption was last spring. And, you know, a lot of that was simply this issue we've been talking about here of people missing care. People not getting care, of care getting delayed or postponed or canceled and that's really what was driving it.

NNAMDIDr. Edwin Chapman, you lead the Medical Home Development Group, a clinic specializing in addiction medicine in Northeast Washington D.C. What has this last year been like for you?

CHAPMANSo, Kojo, addiction medicine especially opioid treatment, which is what we do, has been drastically altered. We have three medications that are typically used in opioid treatment as replacement medications. You're most familiar with methadone. The other two are Buprenorphine or Suboxone, which is probably the name most familiar to people and Naltrexone or Vivitrol, which is an injectable. So, these are medications that actually have to be distributed to the patients.

CHAPMANSo, we had to really change our office procedures not only in terms of how the waiting room was set up in order to maintain social distancing, but we have a large population of homeless patients or patients who have housing struggles. So, getting in contact with my patient population, which is about 250 that I see every month, is difficult. They don't always have telephones. They don't always have minutes on those phones. So, we actually had to come into the office to see those patients and to provide their prescriptions.

CHAPMANSo, it was challenge initially. Some of the methadone clinics and in our office, we would provide a bit more medication than normal. In the methadone clinics patients generally have to go every day. So, they changed their system such that they were giving more than the daily dose and giving patients take-home. And there is some associated risk in that.

CHAPMANThe other problem is isolation is a dangerous situation for any type of addiction. So that instead of having access to their counseling services, many of those services that were either terminated or turned to tele-visits as a replacement. So, it has been quite a challenge from the logistical standpoint.

NNAMDIDr. Chapman, you, it is my understanding, had COVID-19 yourself back in December. Can you tell us about your experience?

CHAPMANSo, my wife got tested on about the 18th of December. And I was feeling fine, but decided that I needed to get tested if she -- and she came back positive. So, I got tested the next day. And I was negative. But then I began to have some symptoms. But because of the fact that I knew she was positive then I decided that I would self-quarantine at home. So, starting on the 20th, 21st, 22nd and 23rd, I did tele-visits from home with my office staff in the office. Then one of my office workers noticed that she was ill on the 23rd. So, we had two days off, Christmas Eve, the 24th and 25th.

CHAPMANMy office worker got tested and she was positive. So that really created a dilemma meaning that my whole office would virtually have to shut down, so I contacted the D.C. Health Department explaining the circumstances to them. But because, again, of the patient population there's no way that I could abandon 250 opioid abuse disorder patients. We're talking about heroine and fentanyl. So, they had to get their medicine. We had already set the office up with a plexiglass between the waiting room and reception area. So, I was allowed to come in and write prescriptions. And fortunately, I was able to cover the office for two weeks alone.

NNAMDIWow.

CHAPMANAnd nobody missed their medicine.

NNAMDIGot to take a short break. When we come back, we'll continue this conversation with Dr. John Marshall. I'm Kojo Nnamdi.

NNAMDIWelcome back to our conversation about delaying healthcare. We're now going to be talking with Dr. John Marshall. He's chief of hematology and oncology at MedStar Georgetown University Hospital. He coauthored a book with his wife, Liza, called "Off Our Chest, An Inside Look at the World of Cancer Caregiving." That book comes out April 6.

NNAMDIDr. Marshall, cancer is a treatment not generally thought to be elective. Most people don't want to opt out, even in the midst of a pandemic. But how has the pandemic changed the way you work?

MARSHALLKojo, thank you. I mean, really, from day one, we had to think about everything differently. As you said, cancer is not elective. We had patients on clinical trials, under active treatment, scheduled for surgeries, and these could not be delayed indefinitely. So, in the world of cancer, we had to face, essentially, every direction.

MARSHALLWe had to help support our team that was going to be on the front line, caring for COVID patients, but on the back side we had to make sure our patients continued to have access to state-of-the-art cancer care. Now, one of the things we also did is we had to learn on the job, because we had to understand the safety and the impact on our patients who may be particularly more vulnerable.

MARSHALLAnd I just want to give a shout-out to not only our region here, in the D.C. region, but also on a global scale. The collaboration that went on behind the scenes, really, in the absence of any governmental help or oversight, the medical community collaborated at a level I've never seen before to try and learn as quickly as we could about the disease itself, of COVID, and how it would impact others.

MARSHALLAnd in particular for us on cancer care. So, as you say, we had to make significant alterations. Yes, tele-visits were important, but that could not replace an operation or a treatment with medicine such as chemotherapy. So, we had to hybridize or mix all of these things, and I think we really did a very good job.

MARSHALLWe maintained as best we could through the early months, and then, essentially, we're back up to really full speed, and even higher than full speed because of the backlog, including maintaining access to research. So, I really -- it's a shout-out to no individual, but a dramatic team, all-hands-on-deck effort to maintain treatment for cancer patients in our community.

NNAMDIHere is Susan, in Maryland. Susan, you're on the air. Go ahead, please.

SUSANSure, Kojo. I thought it might help people to know that if you have to go to the hospital, they're very good at separating your problem from the COVID patients. For example, I didn't expect to have to go three times since COVID started: Once to the ER in June, once for surgery that couldn't be delayed in September, and again into the ER in January.

SUSANAnd each time, to my surprise and pleasure, actually, they had me very separated, once in orthopedics, and both other times not for COVID-related illnesses. And, in fact, in January, the staff around me had had their COVID vaccinations and was very open about that.

SUSANSo, it didn't feel like I was on the verge of being inundated with COVID patients, and I just thought I would share that. I did not expect to go three times.

NNAMDIThank you very much for sharing that story. But Dr. Marshall, there's another aspect of being in a hospital. You have spoken about the impact of isolation and loneliness on hospital patients. What did you notice?

MARSHALLYeah, early on, it was very obvious that the importance of a caregiver when you're admitted to a hospital for anything -- but certainly, in our world, it was cancer patients. We are so used to having a spouse or a friend or a family member at the bedside of every patient in the hospital.

MARSHALLAnd, early on, we had fairly tight restrictions about visitors, and so patients were there in a vulnerable state without that person. And yes, there was video connections, and yes, our team did an amazing job of serving as that sort of temporary family member.

MARSHALLBut we clearly saw the importance and the value of caregivers, certainly in the battle against cancer, in that window, and have done everything we can to patch that together to really fill that void for our patients.

NNAMDIDr. Chapman, black and Latino communities have been disproportionately impacted by this virus. Were you surprised by the extent of the disparities?

CHAPMANAbsolutely not. And I'd have to admit that, well, somewhat amazed that this has been a revelation to the rest of the country. But we knew this all along, that health disparities existed. The other thing that was quite evident was with the job losses early on in the epidemic. We can see how closely related health insurance is to those jobs and the fact that we are the one country, or the one industrialized country that does not have a national health plan.

CHAPMANSo, this is a glaring -- really shows that glaring gap in care -- when people lose their jobs, they also lost their health insurance. And that, I think, hopefully, will be a lesson going forward. But, you know, I'm still somewhat skeptical with our current political situation.

NNAMDIEmma Court, what have you found in your reporting on why both COVID and non-COVID-related health issues have hit black and Latino communities so much harder?

COURTYeah, this is such an important and critical issue, and it's sort of interesting, how these COVID issues and non-COVID issues are linked in this way. Because if you think about the disproportionate impact that COVID has had on black and Hispanic communities, one factor there -- not the only factor, certainly -- is that these are communities that have higher rates of chronic conditions, and we know people with other medical conditions due tend to have these more severe COVID illnesses.

COURTSo, if you think about that, and then think about this other issue of worse access to care for non-COVID care, you can also think about this and the impact that it could have on communities of color, as well. And while it's still early, there's some evidence already that when you have worse access to care overall, in-person care, communities of color also have a harder time getting access to care.

COURTAnd so, this threatens to obviously exacerbate some of these already higher rates of chronic health conditions. And it's something that is on a lot of people's minds. You know, a thing that comes up a lot is this question about telemedicine. There's been expanded access to telemedicine during the pandemic.

COURTBut as your guests here today have been talking about, not everyone can access telemedicine for various reasons, including issues of perhaps not reliable Wi-Fi, or you don't have the devices you need, or you're not comfortable using them, and it's something that came up. I spoke with a physician at a clinic in Baltimore that sees a lot of patients living with HIV.

COURTAnd she said that telemedicine isn't helping us, and we're actually trying to make more room for people to come in in person, because of all these problems.

NNAMDIDr. Chapman, pursuing this issue a little more, black Americans lost 2.7 years of life expectancy in 2020. Latinos lost 1.9, and white Americans lost 0.8 years. Has what Emma said, what Emma just explained is at least a partial explanation for why this is happening, and what do you think needs to be done to address it?

CHAPMANAbsolutely. And the other issue is the fact that because of the type of employment that African-American and the Latino community participate in -- the so-called "essential workers" -- that that creates a problem. So, when you link that to economic circumstances, housing, homelessness, just imagine a homeless person that passes out in front of my office is picked up by the EMTs to take them to the hospital.

CHAPMANThen that person comes in contact with the nursing staff in the emergency room, and if the person is admitted to the floor or has to go to ICU, and if that person has COVID, then everybody has been exposed. So, it's really -- it really spares no one, because the doctors and the nurses, obviously, are high-income people, well-educated, but they too are impacted, because they're essential workers.

CHAPMANSo, really shows how we are tied together as one community, especially because of this pandemic. There is no such thing as no man -- well, it tells us that no man is an island, that we're all linked together.

NNAMDIA listener tweets: I can't imagine how many dentist appointments are being put off, too. My whole family has been for our regular cleanings. It felt very safe for us. And now here is Jennifer in Falls Church, Virginia. Jennifer, you're on the air. Go ahead, please.

JENNIFERThank you for taking my call. I kind of had the opposite experience that an earlier caller had when she said she felt very safe in the hospital during her visits. Unfortunately, last year, I had three ER visits for two different problems, and then a surgery in December to fix that problem.

JENNIFERBut I didn't want to put off that surgery, and then later in the year, felt like I needed to get it done as soon as possible, because of the surge coming around Christmas. But my experience in the waiting room was not good.

JENNIFEROnce I got into the hospital with the paramedics, I felt very safe. Everyone was masked up, they had lots of protocols. But when I went on my own and checked myself in, the waiting room was just, like, no-man's land. There were people everywhere, coughing, you know, all kinds of symptoms.

JENNIFERThe only screening that had been done was a guy at the door that asked me if he -- if I thought I had COVID, and I said no. And he put a sticker on me and said, "Go wait over there," with another 20, 30 people. Plus, when I got discharged from that, or discharged from all three of those visits, actually, I was just kind of put out on the street.

JENNIFERSo, there wasn't any -- I had gone by myself, and like I said, with the paramedics two times. So, sitting around in the waiting room was very dangerous, I felt, and there wasn't any direction about how to protect myself, at that point.

NNAMDIThank you very much for sharing that with us. Dave in Gaithersburg emailed kind of a similar experience: I visited Shady Grove Adventist emergency room with catastrophic urinary symptoms. After installing a foley catheter, I was thrown out of the building in the bitter cold, wearing a light sweater, because of COVID.

NNAMDII had to wait nine hours for the buses to resume running. I'm assuming, Dr. Borden, that both in the cases of Jennifer and Dave this may have happened a little while ago. Are things different now? Should the fact that many healthcare workers are now vaccinated give patients even more reason to be confident about seeking care? And what about what goes on in the ER?

BORDENYeah. Well, one, I'm sorry to hear about those experiences, because, obviously, we -- and I speak for healthcare community as a whole -- is, you know, we try and provide safe, effective care that is also a good experience. So, it saddens me to hear about those experiences, because we, as a healthcare community, need to do better.

BORDENSo, I think that there's a lot of learning that went on very early in the pandemic, and I think that Dr. Marshall talked about this, is we were all figuring out how to adapt. I think we adapted pretty quickly, and I agree with his comments on the healthcare community pulling together to put together our safety measures and protocols.

BORDENAnd, you know, it is not the same experience as it would have been sort of 13, 14 months ago, but I think in many ways, it's really structured around safer flow through the hospital. And I think it's similar safety protocols in many ways to what we're doing in the rest of our lives. So, masking, keeping physical distancing, washing our hands.

BORDENAnd then, at many hospitals and clinics, there's really enhanced screening. You know, many places, including our hospital, we're testing people before they come in, get admitted to the hospital, so that we're able to identify people who are COVID-positive, and able to isolate them.

NNAMDIEmma, in-person visits to the doctor may have declined, but telemedicine has seen exponential growth this past year. What's the story of telehealth this year?

COURTRight. I mean, this has been a transformative year for telehealth. It's something, as a healthcare reporter, I have heard about for a long time, and you're always hearing companies saying this is the next new thing in medicine and health. And for 10 years or longer, because they were saying that, and the reality had been, prior to the pandemic, most people didn't know how to access telemedicine. Their health insurer might not pay for it.

COURTThey didn't know if they did have access to it, even that they did or how to get to it. And so, the radical transformation in that industry has been really, really striking, this past year. I mean, you see these numbers that telemedicine use went up thousands of percentage points. So, really, a big change, and you're seeing a lot of that in terms of the business trends, as well. These are companies that are raising a lot of money, now.

COURTThey're doing deals, this is an area of medicine that has really kind of been invigorated by this pandemic, and you can expect to see a lot more of that moving forward. I don't think telemedicine is going away.

NNAMDIAaron in Annapolis emails us: I ended up visiting the Emergency Department at Johns Hopkins during the holidays because of a chest pain. Making the decision to go in was extremely difficult, but as soon as I walked in, I was immediately comforted by COVID screening and prevention procedures in place. Patients were isolated until test results came in."

NNAMDIOverall, I think I made the right decision. I would like to thank all of the healthcare professionals for everything they have been doing for us. I'd like to hear from you -- both you, Dr. John Marshall and Dr. Bill Borden, about this. First you, Dr. Borden: Is this what people should expect today?

BORDENIt is, and I'm glad that you had that experience. I think, you know, comparing with the experience that the other callers had earlier, I think the experience you're describing that you had is what the vast, vast majority of people are experiencing, which is there are good protocols and processes in place. There's screening mechanisms keeping patients who are COVID-positive separate from patients who are not COVID-positive. And really, I think, you know, hospitals have figured out how to safely and effectively treat people, even in this era of the pandemic.

MARSHALLYeah, I might add to that, in a cancer clinic, we decided to put in some additional screening because we considered our patients to be potentially more vulnerable because of immunosuppression. So, we had additional screening in front of our entryway, and we just decided last week that, in fact, our front door screening was so effective, that we never caught another person using that second step.

MARSHALLSo, this is our standard now, and we're really very pleased about how that's gone and how safe we do feel, and I believe our patients feel when they are in our hospitals.

NNAMDIDr. Chapman, same question to you.

CHAPMANYes, we actually spread our schedule out so that we never had more than four patients in the waiting room at any given time, and again, did temperature checks with patients coming in. And from our experience, none of the patients were impacted or got COVID from the office contact.

CHAPMANI think most of our problems were external to the office, bringing in the COVID from outside. So, it's been -- it has changed everything in terms of treatment, the telemedicine, the screening. We hope that all of that remains in place.

NNAMDIHere is Marie in Wallops Island, Virginia. Marie, you're on the air. Go ahead, please.

MARIEOh, my gosh, I'm so nervous being on the air. But I just wanted to let everyone know that I had COVID in April, and I couldn't even get tested, and it made me sick for, eh, six weeks, at least. But the mental isolation, you know, I used to volunteer, you know, I worked at the library, I worked with Kiwanis, I, you know, worked at the visitor's center at Wallops, at NASA. It's all shut down. And mentally, it's been very, very difficult.

NNAMDII'm glad you raised that issue. Emma Court, have you at Bloomberg News been able to look at the mental health issues being raised by the pandemic? And I expect that a lot of them are being dealt with through telemedicine.

COURTYeah, there's been a tremendous amount of mental health struggles during this pandemic. I think, you know, one of the clinicians on this show raised it earlier, as well, this idea that isolation can be a really --

NNAMDIYes.

COURT-- difficult condition for struggling with addiction. And isolation is tough for everyone, right? And I think you see it kind of across the spectrum. I know many frontline medical providers were very much struggling with the difficult conditions of being out on the frontlines of this pandemic, not always having adequate protective equipment, being afraid of transmitting the virus, getting it themselves, but also transmitting it to their families.

COURTAnd so, I think when you look across the spectrum, really, everyone's had their own version of these struggles. And yes, you've also seen a lot of increased interest in getting mental health care via telemedicine. I'm hearing stories about therapists so busy, they have to turn people away. And it really does raise the question of whether our systems can support the new conditions during this pandemic.

NNAMDIMonica, a family physician in D.C. called, but couldn't stay on the line. She said it's been a struggle for both patients and providers to just learn as we go, but I'm hoping the pandemic will shed light on the lack of access to healthcare and health inequities that exist in our system, so we can work towards trying to eliminate these inequities. Is that a sentiment that you share, Dr. Chapman?

CHAPMANAbsolutely, and that was really what I was talking about when I mentioned national health insurance. You know, the conversation always turns to socialism, but in the previous administration, we had a situation where even for Medicaid, patients were -- they attempted to make it so patients had to work or do community service in order to keep their Medicaid.

CHAPMANBut if you can imagine trying to locate a Medicaid patient to renew their Medicaid if they're homeless or they don't have a telephone. And so, patients, again, we see a system that I call really eugenics healthcare, in that it's almost survival of the fittest, and that we're excluding the most vulnerable. So, I think the conversation around national health insurance has to be held. But again, I'm very skeptical, after observing some of the things that have happened in the past month or so, and the political response.

NNAMDIHere now is Diana in Falls Church, Virginia. Diana, we only have about a minute left, so go ahead, please.

DIANAWell, thank you, Kojo, for taking my call. Yes, I had a couple of procedures during pandemic. The first one was a colonoscopy. I had a complication via video with my doctor, but because of precondition with (unintelligible) I had to have a procedure done.

DIANAAnd then in December, I had -- this was done in May, and then in December I have an eye procedure done (unintelligible). Everything went fine, I had to do the COVID test to be negative (unintelligible) --

NNAMDIOkay.

DIANA-- prior to the procedure.

NNAMDIBut in the final analysis, what you're saying is that everything went fine.

DIANAYes.

NNAMDIOkay. And I'm afraid that's all -- I'm afraid that's all the time we have. We're just about out of time. Dr. Bill Borden, Emma Court, Dr. Edwin Chapman, Dr. John Marshall, thank you all for joining us to discuss this important issue. Today's show was produced by Julie Depenbrock.

NNAMDIComing up tomorrow, black and brown communities in our region -- and nationwide -- have been the hardest hit by the coronavirus. Now, these same communities are facing low vaccination rates for COVID-19. We're going to be joined by community health leaders to discuss this vaccination gap and how it might be bridged. That all starts tomorrow, at noon. Until then, thank you for listening, and stay safe. I'm Kojo Nnamdi.