August 19, 2020

The most recent Morbidity and Mortality Weekly Report (MMWR), the weekly publication of the CDC, paints a concerning picture of the burgeoning mental health crisis in the United States resulting from the COVID-19 pandemic. Prior surveys by the CDC had already shown increasing symptoms of anxiety and depressive disorders from April to June of 2020, when compared to the same period in 2019, but this most recent survey shows further acceleration of the problem.

July 22, 2020

As we enter the ninth month since the start of the COVID-19 pandemic (the first case has been traced back to November 17, 2019) it is becoming increasingly clear that wearing masks is a critical tool in our toolkit to combat the spread of this novel coronavirus. That’s why the Medical Society took on the role of convening the Mask Up New Hampshire! collaborative of NH businesses and hospitals that aims to raise awareness around the basic safety precautions we can all take to help limit the spread of COVID-19 across the state and keep New Hampshire healthy and open.

July 1, 2020

Since my last blog about racism as a public health crisis, I’ve had a number of conversations with colleagues from around the state about this topic. To a person, everyone was supportive and in agreement with the sentiments expressed. But most of us, even if acutely aware of racism and racial disparities in medicine, feel ill-equipped to tackle this problem. It feels either too big, or too pervasive, or too difficult, and we don’t even know where to start.

At the end of my last blog, I walked through some potential next steps. But the NH physicians I spoke with are all looking for discrete, actionable steps that they can take now, in the context of busy practices and busy lives, along with the specter of COVID looming persistently over all of us.

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.