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A Piece of My Mind
April 27, 2020

Lost Space

Author Affiliations
  • 1Department of Medicine, Division of General Internal Medicine, Harborview Medical Center, University of Washington, Seattle
JAMA. 2020;323(20):2019-2020. doi:10.1001/jama.2020.7237

In early April, we learned that the prior month’s death toll in New York City had been more than twice the normal total. Deaths attributed to coronavirus infections only accounted for a portion of the shocking excess.1 Tragically, the only surprise in this devastating statistic is how quickly it became apparent.

During the period of intense preparation for inpatient surges across the country, primary care physicians have been steeped in a rising anxiety that fills the emptiness of once-bustling offices. At its worst, we feel a helpless dread. In easier moments, we still experience a premonitory exhaustion—knowing that the proverbial “marathon” ahead is insufficiently long and costly to describe what is coming to primary care clinics. Long after the last patient in the United States recovers from the coronavirus disease 2019 (COVID-19), many others will still be afflicted. They will have lost their jobs, and with them, their health insurance. They will have missed office visits and screening tests that might have prevented or delayed illness or even death. They will have suffered emotionally from the stress of isolation, and they will have become fearful of clinics and hospitals. They will have lost access to care in unexpected ways, like the undocumented couple who didn’t come to their appointments last week. When the pair encountered the symptom screening station at the hospital entrance, they left, assuming they would be turned away.

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