June 17, 2020

By now we have all seen the headlines from across the United States about the disproportionate impacts of COVID-19 on communities of color. The CDC has reported an overrepresentation of Black/African American patients among those hospitalized, as well as higher mortality rates for both Black/African Americans and Hispanic/Latinos.[1] New Hampshire is not immune from this reality; where Hispanic/Latinos comprise only 3.9% of the population, they comprised 9.8% of the COVID infections, a disproportionality rate of 2.5, and Black/African Americans comprise 1.4% of the population, but they comprised 6.3% of the COVID infections, a disproportionality rate of 4.5.[2] Meaning these groups are affected 2.5 and 4.5 times their frequency in the population.

I am by nature a planner. I like to stay organized and operate within a clear structure. Prior to assuming the NHMS presidency last November, I spent months planning for my presidency year. After settling on a focus on the social determinants of health, I worked for hours outlining an approach to work through the various social determinants—housing, education, income, food security, employment, and others—over the course of the year, with attention to these factors through the lifespan. 

Like most ambulatory providers in the state and across the country, I have quickly transitioned many visits over to telemedicine visits, either telephone-only or preferably video visits. As a med/peds physician, I have been doing these telemedicine visits across the age spectrum, including well child checks in kids.

We’ve talked a lot over the past few weeks about all the work that the NHMS has been doing at the state level, but I wanted to make sure that physicians in the state know that we are working closely with New Hampshire’s federal delegation as well, to advocate for our patients and for Granite State physicians.

Just over the past couple of weeks, we have had Zoom meetings with Senator Hassan, Congressman Pappas, and Congresswoman Kuster, and a meeting with Senator Shaheen is in the works. We’ve convened a group of your colleagues from around the state, representing various specialties and different practice types from private practice to large health systems to FQHCs, to help our congressional representatives get a sense of what is happening ‘on the ground’ with respect to the COVID pandemic here in NH, and to advocate for a variety of issues that directly affect patients and physicians in the state.

When the COVID-19 crisis really hit New Hampshire, when things really began to change and feel much different, it was right around Friday, March 13. That weekend, we realized that the Medical Society needed to quickly mobilize and respond in any way that we could. We pulled together an emergency meeting of the Executive Committee and had our first meeting on the night of Monday, March 16. That group now meets weekly and has been helping to drive the NHMS response to this crisis. We just had our fifth meeting this past Monday, and were remarking that these past five weeks have seemed like a lifetime.

In a time of crisis, it is normal to feel fear and uncertainty and a feeling of powerlessness. We in healthcare are not immune to this and, in fact, many of us may be feeling this even more acutely given our front-line roles in the COVID19 pandemic with so much still unknown.

As reports roll in from around the world, with the desperate situations in Iran, Italy and Spain, and now reports from our own country—Seattle, Detroit, and New York City—it is easy to feel dismayed and overwhelmed. And yet, at this moment, we need to acknowledge these feelings while still finding ways to do our daily work, because if not us, who?

Two weeks ago, I wrote that the coronavirus outbreak was nearing pandemic status, and that we had just identified our first patient with COVID-19 in New Hampshire. What a difference two weeks makes in this new world we suddenly find ourselves in! 

In that short time, the reality of the situation has become clear here in the Granite State. While our tireless public health colleagues are still working on a containment strategy on a case by case basis (26 confirmed cases with 208 persons with tests pending in NH as of this writing), we have clearly moved aggressively toward mitigation strategies as New Hampshire and greater New England are experiencing pockets of community transmission of COVID-19.

As the new respiratory virus known initially as the ‘coronavirus’ continues to dominate headlines, it seems like a good time to briefly review what we know (and don’t know) about this novel virus and take a look at the current state (as of this writing on 3/4/20).

A novel coronavirus, which likely originated in bats and subsequently gained the ability to spread from animals to humans, and then from human to human, was first detected in China and has now been identified in more than 70 countries around the world, including the US. It has been officially named ‘Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)’, and the respiratory disease that it causes is now being called COVID-19.

A big part of the day to day work of the NHMS is advocacy work for the betterment of NH physicians and our patients. Most of this work involves advocacy at the state level, and as many of you know the Medical Society is well regarded and respected across the political spectrum throughout our state government.

However, the Medical Society also does a fair amount of advocacy work at the federal level, both through our relationship with the American Medical Association (AMA), as well as our ongoing relationships with all four of our national congressional representatives from the Granite State. 

The New Hampshire Medical Society is committed to supporting physician leaders at all levels. A couple of years ago, under the guidance of Deb Harrigan, past NHMS president, the Medical Society was instrumental in helping to develop the New Hampshire Physician Leadership Development Program in collaboration with the UNH Paul College of Business and Economics.

There is another leadership opportunity that is open to all current and aspiring leaders in New Hampshire that you may not have heard of, but is definitely worth your consideration.