As a practicing primary care physician, SPIA alumnus Dr. Deep Shah (AB ’08) is on the front lines of the COVID pandemic. He practices at Gwinnett Clinic, founded in 1983 in his hometown of Lawrenceville, with 18 metro Atlanta locations.
March 2020 introduced the well-regarded practice to a new era, as its longtime tradition of on-the-spot community care was challenged by COVID-related safety considerations and the practical and economic ramifications of the pandemic response.
“The pandemic is revealing that we’ve severely underinvested in primary care and public health––two sides of the same coin,” said Shah.
His office struggled to navigate conflicting COVID-19 protocols, changes to CDC recommendations, and a dearth of personal protective equipment (PPE), all while remaining responsive to the needs and fears of patients and staff. A July 2020 study in the Journal of the American Board of Family Medicine reported that primary care workers may face the highest risk of dying from COVID among medical personnel, as they have less access to proper PPE than frontline hospital staff.
Shah’s practice remained open to patients throughout, though with reduced hours to allow for social distancing and cleaning. Patients are screened before entering, and those presenting with fever or respiratory complaints are seen virtually to ensure a sterile environment. Gwinnett Clinic partners with county health departments to coordinate testing and vaccination.
Meanwhile, primary care practices all over the nation have reported challenges to viability. Declining revenue caused financial stresses, school closures brought on staffing challenges, and the sudden vital nature of telehealth made technological equipment and training an immediate priority.
The COVID national public health emergency has vaulted the practice of telehealth to the forefront of the community response. To assist with these monumental changes, the HHS Office for Civil Rights (OCR) has issued guidance for providers and relaxed HIPAA regulations, so that physicians may, in good faith, provide telehealth services to patients using remote communication technologies, such as FaceTime, Facebook Messenger, Google Hangouts, Zoom, or Skype for telehealth services, even if the application itself does not fully comply with HIPAA rules.
“Like most groups,” said Shah, “we rapidly adopted and implemented telemedicine across our 18 clinics when leadership was trying to wrap its head around how to safely take care of patients in the office. At one point, we saw over 80% of patients using a telemedicine platform or the phone.”
Along with concerns over patient privacy, telemedicine comes with predictable drawbacks. “We’re still learning about the strengths and limitations of telemedicine. Some of the positives are obvious in terms of decreased exposure risk, but the downsides are also evident – we can’t examine the patient or perform any basic tests. But as things stand, at least in our patient population, patients still want to come into the office if we think it’s safe for them to do so.”
The pandemic, said Shah, has exposed weaknesses not just in the nation’s health system but in its primary care infrastructure. Shah joined two other primary care physicians in publishing “Preparing for Primary Care for COVID-20,”  an open letter in the Journal of General Internal Medicine, imploring policymakers to invest in pandemic preparedness, by standardizing protocols and data-sharing processes and providing more support to primary care physicians (PCPs) in the form of PPE and funding.