If you put off a medical appointment during the early months of the novel coronavirus pandemic, you aren't alone. But now that the doctor is (back) in, it could be time to clear your schedule.
About half of the people in the United States postponed or skipped medical care, according to a May 2020 poll from the Kaiser Family Foundation. Out of that number, about one in 10 people said that their health worsened as a result.
People should seek emergency medical care right away if they're experiencing symptoms of a heart attack, have acute stomach pain or are undergoing certain cancer treatments, according to the Centers for Disease Control and Prevention (CDC). But even certain routine doctor's appointments shouldn't always be delayed.
Get tips on how to stay healthy, safe and sane during the novel coronavirus pandemic.
"It's important not to neglect regular health care visits," says Erin Michos, MD, the associate director of preventive cardiology at Johns Hopkins Medicine. "What we do with our health now will affect our health five or 10 years from now."
Here are seven medical appointments you shouldn't skip.
1. Cancer Screenings
Cancer screenings, and even some cancer treatments, plummeted during the novel coronavirus pandemic — a decline that could be responsible for 10,000 extra deaths from breast cancer and colorectal cancer over the next 10 years, according to data from the National Cancer Institute (NCI). (Breast cancer and colorectal cancer account for about 1 in 6 deaths from cancer in the United States.)
This estimate, says Ned Sharpless, MD, the director of the NCI, is "conservative." He adds, "we may see even more excess deaths than the model suggests if we continue to postpone screening, treatment and other cancer care."
Most cancers aren't diagnosed via routine (or asymptomatic) screenings, but rather, by examining people who are experiencing symptoms of certain cancers, he says. If patients postpone their evaluations, then their cancers may be more likely to go undiagnosed or appear later, at a more advanced stage, he explains.
"Not every medical test or treatment can be delayed, even in a pandemic."
If you are 55 or older, and have an average risk of breast cancer, you may be able to push back their next mammogram up to 24 months after their last one, according to the American Cancer Society (ACS). If you've had normal cervical cancer screening results in the past, getting screening at this time "is not urgent," per the ACS. That's because screening with a Pap test shouldn't be done more often than every three years, or, if an HPV test was used, every five years.
For colorectal cancer screenings, some people may be able to take an at-home test such as Cologuard, which can detect abnormal DNA in a stool sample that indicates the presence of colorectal cancer, Dr. Sharpless says.
Keep in mind, however, that these are just general guidelines. Talk to your doctor about whether you should be evaluated in person or whether you can schedule a telemedicine appointment with your doctor.
"The threat of COVID-19 is very real," Dr. Sharpless says. He acknowledges that people are right to be concerned about catching COVID-19. But, "not every medical test or treatment can be delayed, even in a pandemic," he says.
What About Oncology Appointments?
If you're undergoing treatment for cancer, your doctor can tell you whether you should continue with your regimen or whether you can delay any procedures or appointments.
2. Your Child’s Doctor’s Appointment
Even during the early days of the pandemic, the American Academy of Pediatrics (AAP) encouraged parents to keep their well-child visits whenever possible — especially for children under the age of 2, who need to receive vaccines, says Elizabeth Murray, DO, a spokesperson for the AAP and a pediatrician in Rochester, New York.
Childhood vaccinations in particular declined during the COVID-19 pandemic in some parts of the United States. For example, immunizations in New York City dropped by 62 percent among kids under 2 years old and by 96 percent among those aged 2 to 18 during the early weeks of April 2020, per a July 2020 report from the CDC. The data showed that the numbers started to rise again by late spring, but as of June 2020, the figures are still lower than those from 2019.
Adults, Don't Fall Behind on Your Immunizations
Staying on track with vaccines isn't just important for babies and children; adults need to stay current on immunizations, too, according to the CDC. That's especially important in the lead-up to flu season.
If you've put off a routine vaccination, like the flu shot, recombinant zoster vaccine (aka the shingles vaccine) or Tdap immunization (which prevents tetanus, diphtheria and pertussis), try to make it up as soon as possible.
Another reason why babies shouldn't miss their well-child visits is because pediatricians need to make sure that they're developing and growing properly. "If a newborn is not growing well, or perhaps their head size is growing very fast or large, that could be a sign of a problem," Dr. Murray says.
Pediatricians also need to check on the parents, to see how well the family is adjusting to the new baby and look for signs of postpartum depression, she says.
Well-visits are best done in person, rather than via telemedicine. "You really need a good accurate weight and length and a measurement of the head size," Dr. Murray says. Plus, doctors want to listen to babies' hearts with a stethoscope for heart murmurs.
"For a newborn to go more than two months without any type of checkup, that could be potentially dangerous," Dr. Murray says.
Babies’ first well-child visit should be scheduled for the first week of life, per the AAP. Afterwards, babies should see their doctor at months 1, 2, 4, 6, 9 and 12. Between ages 1 and 2, babies should see their doctors at months 15, 18, 24 and 30. Starting at the age of 3, a child's well visits can be scheduled annually.
3. Prenatal Visits
Like other leading medical organizations, the American College of Obstetricians and Gynecologists (ACOG) encouraged doctors during the early stages of the pandemic to use telemedicine whenever possible.
But because people who are pregnant need to have tests like ultrasounds or blood work, they will also need to keep some of their in-person doctors' appointments, says Clara Ward, MD, a maternal-fetal medicine specialist with UT Physicians and UTHealth in Houston.
"While social distancing is critical to reduce the spread of COVID-19, it is important for both medical and psychological reasons to continue prenatal care," Dr. Ward says.
The number of prenatal care visits someone needs — and whether those appointments need to be in person — depends on their individual circumstances, Dr. Ward says. For example, some people (such as those with uncomplicated pregnancies) may have as few as 12 doctors' visits, whereas others will need to be come into the office more frequently for extra monitoring.
Talk to your doctor about how many appointments you may need during your pregnancy, including how many must be in-person visits. Sometimes, doctors are able to group certain procedures — like vaccinations and blood glucose screenings — together, which can reduce the number of in-person appointments you may need.
4. Chronic Condition Check-Ins
If you have a chronic condition such as diabetes or heart disease, it's important to keep up with your routine medical care, Dr. Michos says. "Cardiovascular disease is still the leading cause of death [in the United States]," she says.
The good news is that some people can measure their temperature, respiratory rate, blood pressure and heart rate at home, and keep up with their preventive care remotely, via a telemedicine appointment, she says.
For example, Dr. Michos asks her patients with heart failure to monitor their fluid intake by weighing themselves every day with a scale, and asks those with high blood pressure to monitor their numbers using a home blood pressure cuff. People with diabetes can monitor their blood sugar levels with daily blood glucose tests.
There are instances, however, when a doctor may want to schedule an in-person visit. "Sometimes when patients have heart failure, we need to examine them and listen to their lungs," Dr. Michos says.
If you have any questions about your condition — or think you may be sick — call your doctor, who can tell you where to go and what to do if you need treatment.
If you have asthma, continue to use an inhaler or other medications, and contact your doctor if you're experiencing any symptoms, per the American Academy of Asthma, Allergy and Immunology. You may be able to schedule a telemedicine appointment, but the organization notes that if you're having an asthma exacerbation, you may need to go to the emergency room or urgent care.
If you have an underlying medical condition, do not change your treatment plan without talking to your doctor first, according to the CDC. Keep a 30-day supply of prescription (and non-prescription) meds on hand, per the CDC.
5. Blood Tests
Even if you're able to meet with your doctor via telemedicine, you may still need to get blood work done at a lab.
This may be the case for you if your doctor needs to determine if your medication is working properly. Taking too much of a certain drug could cause unintended side effects, whereas taking too little of it may not treat your condition, according to the U.S. National Library of Medicine.
"If people are on blood pressure or cholesterol medicines, we need to get labs to make sure their kidney function is normal and [know] how well their cholesterol is controlled," Dr. Michos says.
Just as people can go to the grocery store safely, people can go to the lab safely, she says. Wear a mask and stay 6 feet apart. Like doctors' offices, labs have also implemented precautions, she says. Some will even allow you to wait for your appointment in your car instead of in the waiting room; the staff will send you a text when you're able to come in.
6. A Dentist Visit
There's a strong link between good oral health and good overall health, says Matthew Messina, DDS, a spokesperson for the American Dental Association.
Even a seemingly minor problem — like a lost filling or a chipped tooth — can quickly turn into a bigger issue. "If someone has a hole in their tooth, food and bacteria can get packed into the tooth and accelerate the rate of decay," he says. Tooth decay, or cavities, can progress especially quickly if the inner layer of a person's tooth (the dentin) becomes exposed, Dr. Messina says. Left untreated, cavities can require a root canal or crown, or the tooth may even need to be extracted, per the Mayo Clinic.
"By the time it becomes painful," he says, "the [problem] is already a lot bigger than it needed to be."
In general, it's a good idea to visit your dentist once every six months for a routine checkup and cleaning, Dr. Messina says. But if you have a bump or other new growth in your mouth that doesn't heal within two weeks, ask your dentist to take a look at it. An injury — like a cut from, say, biting down on a nacho chip — should heal within that time, he explains; more serious growths, like oral cancer, won't.
When it comes to routine dental care — like your checkup and cleaning — delay the appointment until the COVID-19 transmission rates are "reduced from community transmission to cluster cases," or until local health officials OK routine dental care, per August 2020 interim guidance from the World Health Organization (WHO). This guidance is because the nature of dentistry puts dentists and hygienists at a high risk for getting infected with the novel coronavirus, or spreading it to patients, per the WHO.
"The good news is that dental offices are incredibly safe spaces to be seen," he says. Dentists have been wearing personal protective equipment (PPE) such as masks, gloves, glasses and gowns, as well as thoroughly cleaning their treatment rooms and medical equipment, since long before the COVID-19 pandemic.
If you're generally healthy (and not at a high risk for severe illness from COVID-19), infections rates in your community are low and your local health officials have given dental offices the go-ahead to open, consider visiting the dentist for your routine cleaning.
Or, if you're averse to scheduling an in-person appointment, and have a question about your oral health, call your dentist. They might be able to use teledentistry (yes, telemedicine for dentistry exists) to look inside your mouth and examine any suspicious sores or cracks, Dr. Messina says.
7. A Trip to the ER
During the early stages of the pandemic, people avoided the emergency room because they were afraid of catching COVID-19 — so much so that ER visits dropped by 42 percent from the early spring of 2020 to the early spring of 2019, according to a report from the CDC.
But just because people aren't going to the emergency room doesn't mean that they aren't experiencing an emergency.
"People were ignoring heart attack and stroke symptoms, and unfortunately, we've been seeing some of the devastating consequences," Dr. Michos says.
"The safest place to be in an emergency is the emergency department."
While no one makes an appointment to go to the ER, it's important not to stay at home if you think you need urgent medical care. For example, delaying care for a heart attack could cause serious long-term complications, including aneurisms, heart valve problems or holes in the heart, Dr. Michos says. Delaying care for a stroke could cause permanent brain damage.
"The sooner we can restore blood flow [to the heart and brain], the better," Dr. Michos says.
This drop in ER visits led the American Heart Association (AHA) to launch the "Don't Die of Doubt" campaign, urging people to visit the emergency room if they're experiencing symptoms of a heart attack (such as chest discomfort and shortness of breath) or stroke (such as facial numbness or arm weakness).
The AHA points out that hospitals are taking precautions to limit the spread of COVID-19: Many have separate rooms for people who have the virus and who are suspected of having the virus, and staff members wear PPE and wash their hands regularly.
"The safest place to be in an emergency is the emergency department," Dr. Michos says.
Concerned About COVID-19?
Read more stories to help you navigate the novel coronavirus pandemic:
Is This an Emergency?
- Kaiser Family Foundation: "KFF Health Tracking Poll - May 2020"
- Centers for Disease Control and Prevention: "Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic"
- American Cancer Society: "Cancer Screening During the COVID-19 Pandemic"
- CDC: "Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID-19 Pandemic — New York City, March 1–June 27, 2020"
- CDC: "COVID-19 and Routine Vaccination"
- AAP: "AAP Schedule of Well-Child Care Visits"
- American College of Obstetricians and Gynecologists: "COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics"
- American Academy of Asthma, Allergy and Immunology: "COVID-19 and Asthma: What Patients Need to Know"
- CDC: "People with Certain Medical Conditions"
- U.S. National Library of Medicine: "Therapeutic drug levels"
- Mayo Clinic: "Cavities/tooth decay"
- CDC: "Impact of the COVID-19 Pandemic on Emergency Department Visits — United States, January 1, 2019–May 30, 2020"
- American Heart Association: "Don't Die of Doubt"
- AHA: "5 reasons hospitals are safe for heart, stroke emergencies — even in the pandemic"
- World Health Organization: "Considerations for the provision of essential oral health services in the context of COVID-19"