Last updated 13 May 2020 2:01PM CST

"What we need in a pandemic is not social distancing, but physical distancing with social connectedness." 
– Kurt C. Stange et al, Physical Distancing With Social Connectedness

This page serves as a rapidly changing index of COVID-19-related content relevant to primary care. For push notifications when new content is added to this collection, please follow @AnnFamMed on Twitter and subscribe to COVID-19 email updates.

Links to new open-access, pre-print, pre-peer review COVID-19 articles will be added to this page as they are vetted by our Associate Editors and Editorial Team. If you would like to submit original content, please see our COVID-19 Collection Call for Papers.

AnnFamMed COVID-19 Preprint Collection

Innovation: Transforming Clinical Workflow for Telemedicine Visits in the COVID-19 Pandemic
Sirisha Mohan, MD, Wilson Lin, Anjali Mahoney, MD, and Jehni Robinson MD1

The Department of Family Medicine at Keck Medicine of USC has expanded its telehealth services to all providers across all clinical sessions and locations. Initial workflows developed for telemedicine visits fell short in capturing the documentation required for compliance, risk, and quality metrics. To address these needs, the workflow was redesigned to integrate receptionists, medical assistants, and providers.

29 May 2020. Nonrefereed, online collection only. Permanent  URL: http://hdl.handle.net/2027.42/155452

Essay: Addressing Food Insecurity During COVID-19: A Role for Rural Federally Qualified Health Centers
Arvind Suresh, BA, Arhem F. Barkatullah, BS, and Maureen B. Boardman, MSN

Past pandemics have revealed that populations served by the primary care safety net require resources beyond federal and state aid programs. At one federally qualified health center, staff have adapted their food prescription program for patients with chronic diseases to a home delivery service, which leverages existing relationships between care coordinators and patients.

29 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155450

Special Report: Quick COVID-19 Primary Care Weekly Survey & Press Release, Week 11
Rebecca Etz, Advisory Group, Larry A. Green Center

"As before the pandemic, we continue to give vital care to our patients without a vehicle for reimbursement. This was not a sustainable model for our practice even before the pandemic. The pandemic may kill my practice. Texas" On Friday, March 13, 2020, The Larry A. Green Center launched its first weekly Quick COVID-19 Primary Care Survey to assess the impact of COVID-19 on practices. This survey has since been repeated weekly. These are the results from week 11. 

29 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155447

Special Report: COVID-19 Patient Primary Care Survey, Series 1 Fielded May 4-11, 2020
Rebecca Etz, Advisory Group, Larry A. Green Center

"I greatly appreciated my doc proactively sending out email to all his patients at the beginning and twice since letting us know the concerns with our specific chronic illness and what we need to do to protect ourselves. This has a lot to do with why I trust him so much." On Monday, May 4th, 2020, The Larry A. Green Center launched its first weekly Quick COVID-19 Primary Care Survey to assess the impact of COVID-19 on patients.These are the results from Series 1.

29 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155448

Special Report: Quick COVID-19 Primary Care Survey of Clinicians: Summary of the fourth (May 15-18, 2020) pan-Canadian survey of frontline primary care clinicians’ experience with COVID-19. (English and French)
Wong, Sabrina RN, PhD; The Primary and Integrated Health Care Innovations Network; The Canadian Institutes for Health Research Strategy for Patient Oriented Research; Advisory Group, Larry A. Green Center 

On Friday April 10, the SPOR PIHCI Network, in partnership with the Larry A. Green Center, launched the weekly Canadian Quick COVID-19 Primary Care Survey. Weekly results are available in English and French and an invitation to primary care clinicians across the country to participate opens weekly (http://spor-pihci.com/resources/covid-19/). Series 4 results.

28 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155430

Essay: Community Health Centers Poised to Weather Uncertainty from the COVID-19 Pandemic: Lessons from the Past, Reflections on Federal Program Durability 
Evan V. Goldstein, MPP

Like most sectors of the U.S. health care system, federally-funded community health centers (CHCs) face new challenges imposed by the COVID-19 pandemic. However, important lessons from the past and recent history serve to remind us that COVID-19 will not deliver a fatal blow to the federal CHC program – and most CHCs and their clinicians will weather this new storm of uncertainty while continuing to provide invaluable services to persons who need them most.

22 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155401

Special Report: Quick COVID-19 Primary Care Weekly Survey & Press Release, Week 10
Rebecca Etz, Advisory Group, Larry A. Green Center

On Friday, March 13, 2020, The Larry A. Green Center launched its first weekly Quick COVID-19 Primary Care Survey to assess the impact of COVID-19 on practices. An invitation to participate was distributed to 9,000 primary care clinicians across the country and remained open until March 16, 11:59pm PST. This survey has since been repeated weekly. These are the results from week 10, plus a press release from the Larry A. Green Center and the Primary Care Collaborative.

22 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155400

Special Report: Remote Options for Medication Abortion: Improving Patient Care During and After the COVID-19 Crisis
Tara Stein, MD, MPH, Ian Lague, MS, Marji Gold, MD, and Jessica Beaman, MD, MPH

Medication abortion is an essential, time-sensitive service that is particularly well-suited to telemedicine provision, including in primary care settings. As primary care providers, the authors advocate for high-quality, low-risk abortion care for patients without point-of-care exams and labs. The discussion includes a detailed checklist for providing such remote-care medication abortion in a variety of settings. Such strategies will allow more clinicians to offer this essential care both during and after the COVID-19 crisis.

21 May 2020. Nonrefereed, online collection only. Permanent  URL: http://hdl.handle.net/2027.42/155399

Essay: COVID-19 and the school-based mass preparticipation physical evaluation: The anvil that broke the camel’s back?

Andrew Cunningham, MD

The preparticipation physical evaluation is required in the vast majority of states for participation in high school athletics. These examinations are commonly performed at school- based mass events. Given the current climate surrounding the COVID-19 pandemic and recommendations for social distancing, primary care and sports medicine providers should use this opportunity to encourage athletes to have their preparticipation physical evaluations performed by their primary care provider in their medical home in accordance with recommended best practices both now and in the future.

21 May 2020. Nonrefereed, online collection only. Permanent  URL: http://hdl.handle.net/2027.42/155398

Special Report: Developing a COVID-19 Medical Respite Unit for Adults Experiencing Homelessness: Lessons Learned from an Interdisciplinary Community-Academic Partnership
Katherine A. Nash, Benjamin A. Howell, Emma Lo, Jaclyn Portanova, Keitra Thompson, Philip Costello, Alison Cunningham, Mehul Dalal, Sarah B. Lipkin, David I. Rosenthal, and Angela Martinez-Strengel

The authors, a group of public health officials, clinicians, academics, and non-profit leaders, partnered with the City of New Haven, Connecticut, to develop a COVID-19 medical respite program for people experiencing homelessness in their community. They describe the key processes and challenges inherent to designing the COVID-19 respite, including: the balance between patient autonomy and a public health agenda; how to deliver trauma informed, equitable, patient-centered, high-quality care with low resources; and approaches to program evaluation.

21 May 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155396

Original Research: Social Distancing Metrics and Estimates of SARS-CoV-2 Transmission Rates: Associations between mobile telephone data tracking and R
Christopher P. Morley, Kathryn B. Anderson, Jana Shaw, Telisa Stewart, Stephen J. Thomas, Dongliang Wang, 

Social distancing may be flattening the epidemic curve, but it is also blamed for severe economic consequences. It is therefore essential to demonstrate whether the costs of social distancing are having the desired effect. In this brief report, we present a tool for tracking community contact rates and, thus, transmission potential.

20 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155389

Special report: Why a shortage of ventilators should not be the take-away from COVID-19: The case for primary care
Deborah Edberg, MD, Santina Wheat, MD, MPH

The current COVID-19 crisis has rightly highlighted severe shortages in ICU personnel, ventilators and other ICU equipment. It is critical to remember, however, that aside from this particular crisis, our healthcare needs were not revolving around this specific type of care. During and after the current pandemic, it is crucial we continue to emphasize the role and importance of primary care in improving the health care system and the overall health of the people of the United States. 

15 May 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155364

Special Report: Quick COVID-19 Primary Care Weekly Survey, Week 9
Rebecca Etz, Advisory Group, Larry A. Green Center

On Friday, March 13, 2020, The Larry A. Green Center launched its first weekly Quick COVID-19 Primary Care Survey to assess the impact of COVID-19 on practices. An invitation to participate was distributed to 9,000 primary care clinicians across the country and remained open until March 16, 11:59pm PST. This survey has since been repeated weekly. These are the results from week 9.

15 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155365

Special Report: Quick COVID-19 Primary Care Survey of Clinicians: Summary of the third (April 24-27, 2020) weekly pan-Canadian survey of frontline primary care clinicians’ experience with COVID-19. (English and French)
Wong, Sabrina RN, PhD; The Primary and Integrated Health Care Innovations Network; The Canadian Institutes for Health Research Strategy for Patient Oriented Research; Advisory Group, Larry A. Green Center 

On Friday April 10, the SPOR PIHCI Network, in partnership with the Larry A. Green Center, launched the weekly Canadian Quick COVID-19 Primary Care Survey. Weekly results are available in English and French and an invitation to primary care clinicians across the country to participate opens weekly (http://spor-pihci.com/resources/covid-19/). Series 3 results.

13 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155354

Innovation: COVID 19 Hotspots And Vulnerable Populations Identified By Area Deprivation Index Mapping
By Niharika Khanna, MD, MBBS, DGO, Elena Klyushnenkova, PhD

The authors used the Area Deprivation Index (ADI) to create an online tool for physicians and target outreach efforts to patients with greatest needs. COVID 19 pandemic is an opportunity for innovation to bridge the digital divide and the ADI is the first step in identifying patients most in need of practice supports.

12 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155341

Original Research: Clinical Features of Covid-19 in Barcelona City
Sisó-Almirall, Antoni; Kostov, Belchin; Mas-Heredia, Minerva; Vilanova-Rotllan, Sergi; Sequeira-Aymar, Ethel; Sans-Corrales, Mireia; Sant-Arderiu, Elisenda; Cayuelas-Redondo, Laia; Martínez-Perez, Angela; García Planas, Noemí; Anguita-Guimet, August; Benavent-Àreu, Jaume.

In Spain, the first positive case of SARS-Cov-2 was diagnosed on 31 January 2020. As of 7 May 2020, there have been 221,447 cases, the most in any European Union country. This study aimed to describe the clinical, biological and radiological manifestations, the evolution, treatments and mortality rate of patients with COVID-19 infection in the population of Barcelona city.

8 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155329

Special Report: Quick COVID-19 Primary Care Weekly Survey, Week 8
Rebecca Etz, Advisory Group, Larry A. Green Center

On Friday, March 13, 2020, The Larry A. Green Center launched its first weekly Quick COVID-19 Primary Care Survey to assess the impact of COVID-19 on practices. An invitation to participate was distributed to 9,000 primary care clinicians across the country and remained open until March 16, 11:59pm PST. This survey has since been repeated weekly. These are the results from week 8.

8 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/155024

Special Report: Quick COVID-19 Primary Care Survey of Clinicians: Summary of the second weekly pan-Canadian survey of frontline primary care clinicians’ experience with COVID-19. (English and French) 
Wong, Sabrina RN, PhD; The Primary and Integrated Health Care Innovations Network; The Canadian Institutes for Health Research Strategy for Patient Oriented Research; Advisory Group, Larry A. Green Center 

On Friday April 10, the SPOR PIHCI Network, in partnership with the Larry A. Green Center, launched the weekly Canadian Quick COVID-19 Primary Care Survey. Results are available in English and French and an invitation to primary care clinicians across the country to participate opens weekly (http://spor-pihci.com/resources/covid-19/). Series 1 and 2 results.

4 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154873

Special Report: Quick COVID-19 Primary Care Weekly Survey, Week 7
Rebecca Etz, Advisory Group, Larry A. Green Center

On Friday, March 13, 2020, The Larry A. Green Center launched its first weekly Quick COVID-19 Primary Care Survey to assess the impact of COVID-19 on practices. An invitation to participate was distributed to 9,000 primary care clinicians across the country and remained open until March 16, 11:59pm PST. This survey has since been repeated weekly. These are the results from week 7.

1 May, 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154865

Special Report: The use of primary care big data for COVID-19 research: A consensus statement from the COVID-19 Primary Care Database Consortium
Hajira Dambha-Miller, Simon J Griffin, Duncan Young, Peter Watkinson, Pui San Tan, Ashley K Clift, Rupert A Payne, Carol Coupland, Jemma C Hopewell, Jonathan Mant, Richard M Martin, and Julia Hippisley-Cox

The use of big data containing millions of primary care medical records provides an opportunity for rapid research to help inform patient care and policy decisions during the first and subsequent waves of the COVID-19 pandemic. This consensus agreement is aimed at facilitating transparency and rigour in methodological approaches, as well as consistency in defining and reporting cases, exposures, confounders, stratification variables and outcomes in relation to the pharmacoepidemiology of COVID-19. 

1 May 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154864

Innovation: Innovative healthcare organization to deal with COVID-19 in primary health care in the Haute-Garonne department, France
Laëtitia Gimenez, MD, Julie DuPouy, MD, PhD, Bruno Chicoulaa, MD, Pierre Ricordeau, Marie-Eve Rouge-Bugat, MD, PhD, and Stéphane Oustric, MD

Primary care health professionals rapidly developed a collaborative approach, including a shared digital tool, to the management of COVID-19 among hospital health professionals (emergency and infectiology services) and medical regulatory services, and local health, research and governmental stakeholders. The authors identify key elements that guarantee the efficiency of primary care, which remains the “gatekeeper” of a care pathway adapted to the patient's needs.

1 May 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154862

Research Brief: Clinical Registries Could Improve Influenza Like Illness and COVID-19 Surveillance
David H. Rehkopf, ScD MPH, Ayin Vala, MS MS, Andrew W. Bazemore, MD MPH, Lars Peterson, MD PhD, Isabella Chu, MS, Robert L. Phillips Jr. MD MSPH

Capacity for tracking COVID-19 prevalence patterns is hampered by insufficient data, particularly from rural and small communities. The PRIME Registry holds data for 5.4 million patients in 47 states who made 638,983 Influenza-Like Illness (ILI) visits in 2019, mirroring CDC’s ILINet temporal patterns but with higher volume and greater rural penetration. Clinical data registries are viable partners that could fill gaps for epidemic sentinel functions and have rich patient data which may identify factors predictive of COVID-19 morbidity and mortality.

29 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154853

Innovation: Responding to Community Questions During a Pandemic: Development of a COVID-19 Inquiry Group
Sean Robinson, MD, Heather Angier, PhD, Kam Pierce, Anthony Cheng, MD, Brett Lewis, Candidate for MD, Kanwarabijit Thind, Candidate for MD, Eva Davis, Candidate for MD, Asma Lotfi, Candidate for MD, and Frances Biagioli, MD

Oregon Health & Science University Department of Family Medicine formed the COVID-19 Inquiry Group to rapidly identify, evaluate, synthesize, and disseminate existing evidence to answer COVID-19-related questions for their community. After answers to questions from the community are finalized, team administrators submit answers for authorization by an institutional oversight committee. At the end of each day, a report of approved answers is disseminated widely.

28 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154809

Special Report: Quick COVID-19 Primary Care Weekly Survey, Weeks 5-6
Rebecca Etz, Advisory Group, Larry A. Green Center

On Friday, March 13, 2020, The Larry A. Green Center launched its first weekly Quick COVID-19 Primary Care Survey to assess the impact of COVID-19 on practices. An invitation to participate was distributed to 9,000 primary care clinicians across the country and remained open until March 16, 11:59pm PST. This survey has since been repeated weekly. These are the results from weeks 5 and 6.

24 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154774

Special Report: Housing as Health Care During and After the COVID-19 Crisis
Kelly M. Doran, MD, MHS; Stephen Cha, MD, MHS; Richard Cho, PhD; Barbara DiPietro, PhD; Lillian Gelberg, MD, MSPH; and Margot Kushel, MD

The COVID-19 crisis has illustrated clearly that “housing is health care.” The authors describe strategies to mitigate the impact of COVID-19 for homeless populations and for the health care system.
 
23 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154767

Implementation Article: Centering Pregnancy in a Pandemic: A Hybrid Drive-Thru and Teleconferencing Model
Zach Sartor, MD, and Carena Chai, DO

Group care models for prenatal care are currently limited due to social distancing restrictions. This paper highlights one organization's innovation: adapting the CenteringPregnancy model during the COVID-19 pandemic to better facilitate access to obstetrical care.

23 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154768

Rapid Review: The Potential for Cloth Masks to Protect Healthcare Providers from SARS-CoV-2
Ariel Kiyomi Daoud, BA, Jessica Kole Hall, BA, Haylie Petrick, BA, Anne Strong, BA, Cleveland Piggott, MD, MPH

When asked to coordinate a community effort to provide cloth masks for primary care providers in rural Colorado during the COVID-19 pandemic, the authors were surprised at the lack of a review specifically addressing the efficacy of cloth masks for protecting healthcare providers. Their rapid review suggests cloth masks may not provide healthcare workers with adequate protection against viral respiratory infections.
 
16 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154747

Essay: Should We Let Fever Run its Course in the Early Stages of COVID-19?
Alexandre A. Steiner, PharmD, PhD

Experimental and clinical data are discussed in light of the notion that fever is particularly adaptive in the early, less severe stages of an infection, when the benefits of a raised body temperature to immunity far exceed its costs to the host. It is, therefore, reasonable to advise that allowing fever to run its natural course for a few days after the onset of symptoms in COVID-19 may reduce the risk of long-lasting infection and, consequently, the risk of complications.

16 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154746

Essay: The Long Reach of a Pandemic: No One is Immune
John J. Frey III, MD 

The author discusses how the COVID-19 pandemic affects all of us in different ways, including monks in a monastery in rural New Mexico.

13 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154745

Implementation Article: Implementation of Primary Care Pandemic Plan: Respiratory Clinic Model
Kathryn Harmes MD, Grace Jenq MD, Taylor Standiford BS, and Melissa Pynnonen MD

In this article, the authors provide a detailed description of the implementation of phases 2 and 3 of the Primary Care Pandemic Plan as described by Krist et al, delivering care to sick and well patients, as well as ensuring staff safety, through establishing a geographically separated respiratory clinic. 

13 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154742

Essay: Out of Touch
Martina Ann Kelly, MB BCh BAO, MA, PhD, FRCGP, CCFP, and Gerard J.Gormley, MB BCh BAO MD FRCGP FHEA

Covid-19 has rapidly changed physician-patient interaction, from hands-on to hands-off medicine. In this essay, as two family physicians in different continents, we reflect on the meaning of touch in clinical practice and how virtual care is transforming this tacit aspect of patient care.

13 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154740

Essay: Reflecting on COVID-19 in 55 Words
Maureen Grissom, PhD; Rolando Gomez, MD; Abigail Hamilton, MD; Shan Malik, MD; Cristina Marti-Amarista, MD; and Howard Stephen Reinheimer, MD  

In an effort to address the anxiety that the coronavirus may cause for some, our Family Medicine Residency Program held a writing workshop using the 55-Word Story format, with writings specific to the theme of COVID-19. The exercise gave residents time and space to reflect on their own experiences and emotions, generated a great degree support and discussion and provided them a window into what some of their fellow residents were experiencing. 

13 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154739

Special Report: Humanism in Telemedicine: Connecting Through Virtual Visits During the COVID-19 Pandemic
Megha Shankar, MD; Meredith Fischer, MA; Cati G. Brown-Johnson, PhD; Nadia Safaeinili, MPH; Marie C. Haverfield, PhD; Jonathan G. Shaw, MD, MS; Abraham Verghese, MD; and Donna M. Zulman, MD, MS

The COVID-19 pandemic is spurring the massive deployment of telemedicine to prevent risk of infection and address healthcare workforce demands. In primary care, many visits have shifted from in-person to telemedicine, introducing a potential barrier to the human connection that is central to clinical care. We adapted existing frameworks that seek to foster humanism in clinical care-the Four Habits Model and Presence 5-to the virtual care context.

13 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154738

Innovation In Primary Care: Development and Implementation of a COVID-19 Respiratory Diagnostic Center
Amir Barzin, DO, MS; David Alain Wohl, MD; and Timothy P. Daaleman, DO MPH

In response to the COVID-19 pandemic, respiratory diagnostic centers (RDCs) have emerged as a health service model that offers symptom screening and provides diagnostic testing for patients. Primary care and outpatient medical directors as well as hospital leadership at the University of North Carolina Health Care System (UNCHCS) worked collaboratively to design and implement the UNC RDC. In this Innovation, the authors describe how these groups developed a “drive-through” model that allowed assessment in personal vehicles. Important lessons are discussed.

10 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154737

Original Research: Hydroxychloroquine Use in the United States and the Potential Impact of Critical Shortages From SARS-CoV-2
Joshua D. Niforatos, MD, MTS, and Michael E. Johansen, MD, MS

Hydroxychloroquine (HCQ) is in critical shortage in the U.S. because of its use off-label for treatment of viral pneumonia secondary to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The authors argue critical drug shortages related to off-label use for SARS-COV-2 infection could impact hundreds of thousands of individuals who use the medication for rheumatological diseases.

10 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154736

Research Brief: The COVID-19 Pandemic in the Netherlands: Impact on Primary Care
Dr. Henk Schers; Prof. Chris van Weel; Kees Van Boven; Dr. Erik Bischoff; and Dr. Tim olde Hartman

The authors present the first empirical data of the impact of COVID-19 on daily practice of family medicine in the Netherlands, studying the resulting changes in presented health problems and demand for primary care. They stress the importance of securing care for all health problems in primary care’s preparations for a major epidemic, to avoid the collateral damage of health systems’ single-minded focus on the epidemic.

10 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154735

Innovation in Primary Care: Epidemiology of COVID-19 Among People Experiencing Homelessness: Early Evidence From Boston
Travis P. Baggett, MD, MPH; Elizabeth Lewis, MBA; and Jessie M. Gaeta, MD

The authors estimated population frequencies of confirmed COVID-19 cases among adults experiencing homelessness in Boston relative to the Massachusetts adult population. Over a 15-day period, 182 homeless adults in Boston were diagnosed with COVID-19 for an estimated cumulative frequency of 46.3 cases per 1000 persons, as compared to 1.9 cases per 1000 among Massachusetts adults on the same date. The trajectory and burden of COVID-19 cases among homeless adults suggests that cities should prepare urgently for the possibility of a COVID-19 surge in this population.

10 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154734

Special Report: Quick COVID-19 Primary Care Weekly Survey, Weeks 1-4
Rebecca Etz, Advisory Group, Larry A. Green Center

On Friday, March 13, 2020, The Larry A. Green Center launched its first weekly Quick COVID-19 Primary Care Survey to assess the impact of COVID-19 on practices. An invitation to participate was distributed to 9,000 primary care clinicians across the country and remained open until March 16, 11:59pm PST (survey to be repeated weekly).

9 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154717

Essay: Lessons from Week Three of the COVID-19 Pandemic
Sarah C. Ruff, MD

A family physician reflects on how her daily life and work have changed during the COVID-19 pandemic. Despite the many challenges, she believes that we are going to come out of this experience having learned many valuable lessons.

8 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154716

Essay: COVID-19 and the Potential Devastation of Rural Communities: Concern from the Southeastern Belts
Charles Ellis, PhD; Molly Jacobs, PhD; Keith Keene, PhD; Ronny Bell; and Daniel Dickerson, PhD

Five states in the southeastern US (South Carolina, Georgia, Alabama, Mississippi and Florida) were some of the last to enact statewide “shelter in place” mandates. The spread of COVID-19 from urban to rural communities should be alarming. This essay posits that the conditions exist to create the perfect storm for COVID-19 to have devastating effects on rural America, particularly in the southeastern US.

8 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154715

Essay: Practicing Full-Spectrum Family Medicine During the COVID-19 Pandemic
Mary Ann Dakkak, MD

The author, a board certified family medicine physician with a fellowship in surgical and high-risk obstetrics, is working to create a COVID-19 team staffed by family medicine practitioners that will encompass prenatal, antenatal and postpartum women to streamline their care. She relates her experiences adapting to this new reality.

8 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154714

Essay: The Five Phases of Pandemic Care for Primary Care​
Alex H Krist, MD, MPH; Jennifer E. DeVoe, MD, DPhil; Anthony Cheng, MD; and Thomas Ehrlich, MD 

During a pandemic, many more patients are likely to have symptoms and many more of those symptomatic patients will seek care. Nearly all will need primary care, and primary care will need to be there to help them. The authors provide a framework in five waves of needed primary care to address the current COVID-19 pandemic.

6 April 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154687

Essay: The COVID-19 Pandemic: The Urgency of Discussing Goals of Care in Patients with Advanced Illness
Amy Case, MD, FAAHPM
 
As the COVID-19 pandemic unfolds in real time before us, the author has witnessed an increase in the emphasis physicians are placing on timely advance care planning and goals of care discussions, especially for patients with advanced cancer, frailty, or advanced illness. This paper describes the need for goals of care discussions at this critical time, as well as potential barriers to doing so, and lists several excellent resources to help clinicians discuss important topics with COVID-19 patients. 
 
31 March 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154604

Essay: Applying Evidence-Based Medicine Concepts for Dealing with a Pandemic
Allen F. Shaughnessy, PharmD, MMedEd, and Andrea E. Gordon, MD

Given the lack of evidence to support our approach to the COVID pandemic, how should we think about it from an evidence-based medicine point of view? Here are ten points to consider when making decisions.

30 March 2020. Nonrefereed, online collection only. Permanent URL: http://hdl.handle.net/2027.42/154603

Essay: Physical Distancing With Social Connectedness
David Bergman, MD; Christina Bethell, PhD, MPH, MBA; Narangerel Gombojav, MD, MSc, PhD; Sandra Hassink, MD, FAAP; and Kurt C. Stange, MD, PhD

Recognizing and supporting the many ways of investing in relationship has great potential to create a positive sea change in a health care system that currently feels fragmented and depersonalized to both patients and health care providers. The current COVID-19 pandemic is full of opportunity to use remote communication to develop healing human relationships.

Accepted 24 March 2020; In-Press, DOI: 10.1370/afm.2538.

Special Report: COVID-19: Notes from the Frontline, Singapore’s Primary Healthcare Perspective
Wei Han Lim, MBBS, and Wei Mon Wong, MBBS, FCFP

Singapore is known to have promptly instituted aggressive public health and containment measures in response to the COVID-19 crisis. The authors describe their framework for how their primary care clinics are responding to this pandemic in the hope that others may find solutions to their unique needs. ­­

Accepted 26 March 2020; In-Press; DOI: 10.1370/afm.2539.

Family Medicine COVID-19 Front Lines Blog

Introducing our new blog for family medicine case notes from the COVID-19 front lines. This is a non-refereed extension of the COVID-19 online collection. Submit your case notes and on-the-ground primary care experiences to our covidcasenotes@umich.edu team.

Telemedicine and Telehealth in Primary Care from the Annals 

ORIGINAL RESEARCH

Initial Implementation of a Web-Based Consultation Process for Patients With Chronic Kidney Disease 
Nynke D. Scherpbier-de Haan, MD, et al, Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

A Web-based consultation system between family physicians and nephrologists reduces the number of referrals and appears to improve treatment appropriateness among patients with chronic kidney disease. The authors assert these findings support the introduction of telenephrology in primary care as a means of delivering higher quality, more convenient care at a lower cost. They conclude that on a broader scale, e-consultation has the potential to break down walls between primary and specialty care.

Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine 
Jocelyn Charles, MD, MScCH, et al, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. 

This study assessed the feasibility, cost, and satisfaction of a synchronistic telemedicine model that connected patients with multimorbidities with a primary care team that included primary care physician, telemedicine-trained nurses, specialists from psychiatry and internal medicine, as well as a social worker, pharmacist, home care and community coordinator, and other professionals as appropriate, based on the patient’s needs.  All 74 patient survey respondents indicated the intervention improved their access to interdisciplinary resources, and 97% reported feeling hopeful their conditions would improve as a result. Of 21 PCP survey respondents, 100% reported they would use the model intervention again, and 90% reported improved confidence in managing their patient’s care.

Patient Perceptions of Telehealth Primary Care Video Visits 
Kristin L. Rising, MD, MSHP, et al, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University.

This qualitative study of 19 adult patients interviewed after video visits with their primary care clinician found that patients accept and even prefer video visits to in-person office visits. Participants reported feeling comfortable talking with their clinicians over a video call, and they identified convenience and decreased costs as benefits. Primary concerns with video visits concerned privacy, including potential for work colleagues to overhear conversations, and questioning the ability of the clinician to perform an adequate physical examination.

INNOVATIONS

Expanding Primary Care Access: A Telehealth Success Story 
M.R. Gonçalves, RN, et al, Universidade Federal do Rio Grande do Sul (UFRGS) School of Medicine, Porto Alegre, Brazil.

The authors describe a telemedicine project in Brazil that included the development of a teleconsulting hotline, increased efficiencies in referral protocolas, and telediagnosis services. They briefly discuss the program's impact on increasing access to specialist consultations, diagnostic testing, and specialized medical advice to physicians.

Published in External Sources

Editorial: An All-Hazards Approach to Pandemic COVID-19: Clarifying Pathogen Transmission Pathways Toward the Public Health Response (Journal of Environmental Health, published May, 2020) by Christopher Eddy, MPH, REHS, CP-FS, Richard Schuster, MMM, MD, FACP, FRCP (Edin), Eriko Sase, PhD
Covid-19: A Remote Assessment in Primary Care (BMJ published online 25 March 2020) - Trisha Greenhalgh, Gerald Choon Huat Koh, Josip Car
Essay: I’m a Family Doctor Fighting Against Fear and Struggling With Distancing While Trying to Keep my Patients Healthy - (The Conversation published 25 March 2020), Tammy Chang, MD, MPH, MS, family physician
COVID-19 Literature Digital Library compiled by Sachin Shah, MD, MPH UCSF @sachinjshah
Essay: Covid-19: Don’t Forget the Impact on US Family Physicians - (BMJ published 26 March 2020), Douglas Kamerow, Robert Graham Center 
Editorial: Covid-19 is Harshly Testing our Capacities as Physicians and Medical Staffers - (Washington Post published 28 Marhc 2020), Ishani Ganguli, MD, MPH @IshaniG
Essay: Medicine: Before COVID-19, and After - (The Lancet published 31 March 2020), Margaret McCartney, General Practioner, @mgtmccartney
Letter: Postacute Care Preparedness for COVID-19: Thinking Ahead - (JAMA published 25 March 2020), David C. Grabowski, PhD and Karen E. Joynt Maddox, MD, MPH
Guidance for Outpatient Management of COVID-19 - (Live Google document), Jill Fenske MD, Jenna B. Greenberg MD, Elizabeth K. Jones MD, Nell Burger Kirst MD, Feranmi Okanlami MD, MS, Daniel S. Oram MD, Jacob Wasag MD, University of Michigan Medical School Department of Family Medicine
Discussion: In the comments: A 20 March 2020 JAMA editorial calls on readers to share their "creative immediate solutions for how to maximize the use of PPE, to conserve the supply of PPE, and to identify new sources of PPE."

Additional Resources

Centers for Disease Control and Prevention (CDC) - Coronavirus (COVID-19)

National Institutes of Health (NIH) - Coronavirus (COVID-19) Resources and Updates

World Health Organization (WHO) - Coronavirus disease (COVID-19) Pandemic

American Academy of Family Physicians (AAFP) - COVID-19: The Latest Updates

Society of Teachers of Family Medicine (STFM) - Medical Education During the COVID-19 Pandemic

American Medical Association (AMA) - COVID-19 (2019 Novel Coronavirus) Resource Center for Physicians

The Hastings Center - Ethics Resources on the Coronavirus (Covid-19)

COVID-19 Health Literacy Project - Downloadable factsheets in 30 languages, developed by Harvard Medical School students, vetted by faculty clinicians, in collaboration with Harvard Health Publishing